Factors Associated With Left Ventricular Hypertrophy Among Patients Undergoing Hemodialysis at Kenyatta National Hospital

Abstract

Study Background: Cardio-vascular disease (CVD) remains a major health threat among patients with ESRD more so those on dialysis with the rate of cardiovascular disease in those patients being 10-20 times higher than in patients without kidney disease. The cardiorenal syndrome has greatly contributed to this effect with the Left Ventricular Hypertrophy being classified under type 4 cardiorenal syndrome. Left Ventricular Hypertrophy among patients undergoing hemodialysis is highly prevalent at 70% followed by coronary artery disease whose prevalence is at 40% among the cardiovascular complications affecting this group. The presence of LVH is a strong predictor of future cardiovascular events and therefore identifying the factors associated with its occurrence is critical in establishing the various management strategies of LVH. Aim of the study: To determine the factors associated with left ventricular hypertrophy among patients undergoing hemodialysis at Kenyatta National Hospital. Methodology: A descriptive cross-sectional study design was carried out to assess what factors were associated with the occurrence of LVH in this population. An interviewer-administered questionnaire was used to obtain data from 70 participants who participated in the study. Echocardiography investigations were done on each participant to determine the presence of LVH. Data was analyzed using SPSS including descriptive and inferential analysis. Presentation of data was done using tables and narration. Ethical considerations were adhered to during data collection as well as covid-19 protocols to ensure the protection of the participants, principal researcher, and research assistants. Results: Based on the results of the baseline characteristics from the 70 participants who were included in the analysis of data, the mean age was 46.46 years which was within a range that spanned from 18 years to 87 years. Majority (61.4%) of the participants were male. The prevalence of Left Ventricular Hypertrophy among patients undergoing hemodialysis at the renal unit was at 70%. Hypertension = 4.091, df= 1 and p-value = 0.043 had a statistically significant association with LVH and had a high likelihood (OR=2.433) of hypertensive participants having LVH. The presence of hypertensive heart disease from ECHO had a statistical significant association with LVH = 48, df= 1 and p-value = 0.000 and had a high likelihood (OR=177.784) of patient with hypertensive heart disease having LVH. A patient with an elevated pulse rate had also a high likelihood (OR= 1.073) of having LVH. A higher BMI and an extended duration of hemodialysis treatment showed a lower likelihood of being associated with LVH. There was no association between gender, alcohol intake and cigarette smoking with the presence of LVH. Conclusion: The prevalence of left ventricular hypertrophy among patients who are undergoing hemodialysis is high (70%) and has been greatly associated to the presence of hypertension and hypertensive heart disease. This indicates that these patients are at risk of various cardiovascular complications as LVH is an independent risk factor of cardiovascular complications. A higher pulse rate was noted to increase the likelihood of the presence of LVH in a patient. Recommendation: Routine screening of cardiovascular diseases should be done so that there’s prevention and early identification of any cardiovascular conditions such as LVH among patients undergoing hemodialysis such as by the routine use of Echocardiography investigation. More follow up of hypertensive patients to ensure that their blood pressures are well controlled.