dc.description.abstract | Background: Cardiovascular disease (CVD) is a major cause of morbidity
and mortality among patients with chronic renal insufficiency (CRI). CVD is
actually recognised as the leading cause of mortality and morbidity in the
Chronic Renal Disease population. CVD mortality is approximately 10 to 30
times higher in patients treated by dialysis compared with patients in the
general population, despite stratifying for gender, race, and the presence of
Diabetes. After standardising for age, CVD mortality remains 1a-fold higher in
dialysis patients than in the general population, even at the extremes of age
[1],[2]. The high prevalence of CVD in patients beginning dialysis suggests
that CVD begins during or before the stage of CRI. Although there have been
few studies of CVD in CRI, the available data suggest a higher incidence and
prevalence of CVD than in the general population. No Data exists on the
prevalence of cardiovascular risk factors in patients with chronic renal
insufficiency at Kenyatta National Hospital.
Objectives: The aim of the study was to determine the prevalence of certain
established and emerging cardiovascular risk factors, specifically, cigarette
smoking, obesity, hypertension, dyslipidaemias, anaemia,
hyperhomocysteinaemia, poor glycaemic control and left ventricular
hypertrophy, in patients with Chronic Renal Insufficiency seen at the Kenyatta
National Hospital.
Design: Cross-sectional prevalence study.
Setting: Tertiary Hospital (Kenyatta National Hospital), specialist nephrology
clinic.
Patient selection: Consecutive sampling of CRI patients. CRI was defined as
a calculated creatinine clearance of less than 75mls/min (documented twice at
least 1 month apart, with no identifiable reversible cause. (Creatinine
clearance was derived using the Cockcroft-Gault formula. [3])
Variables of interest: Age and sex, cigarette smoking, systemic arterial
hypertension, obesity, anaemia, total cholesterol, LDL-cholesterol, HDLcholesterol,
triglycerides, homocysteine levels, left ventricular hypertrophy,
obesity, and poor glycaemic control among diabetic patients.
Results: Between April and October of 2002, 83 patients with chronic renal
insufficiency were studied, 59 males and 24 females. The underlying aetiology
of the Renal failure was Chronic glomerulonephritis in 36.1 %, Hypertension in
31.3%, Diabetes mellitus in 28.9%, and polycystic kidney disease in 3.6%.
The mean creatinine clearance was 47mls/min (95%CI 27.5-66.5mls/min) with
16.9% having a clearance less than 25mls/min, 34.9% having a clearance
between 25 and 50mls/min, and 48% having a clearance between 50 and
75mls/min.62.7% of the patients had age and sex as vascular risk factors.
There were 6(7.23%) current smokers, all males. The mean BMI was
23.4kg/m2 (95%CI 20.6-26.2), with 32.5% of patients being either overweight
or obese. 15 of the 27 obese patients had central obesity.61.5% of patients
were hypertensive, of these patients,81 % were on anti-hypertensive
treatment. 4.8% of patients had elevated total cholesterol levels.12% of
patients had elevated LDL-Cholesterol levels. 73(88%) patients had low HDLcholesterol
levels. 13(15.7%) patients had elevated triglyceride levels. The
mean Homocysteine level was 24.10mol/1 (95%CI 10.2-38). 77
patients(92.8%) had elevated homocysteine levels. The mean glycated
haemoglobin level among the 24 diabetic patients was 7.43(95%CI 6-8.8),
with 37.5% of patients exhibiting poor glycaemic controI.72.3% of patients had
elevated blood pressures, of these patients, 81% were on anti-hypertensive
therapy and demonstrated less than optimal control. The mean haemoglobin
was 11.6g/dl(95%CI 9.1-14). 49 patients (59%) of patients were anaemic.
Significantly, creatinine clearance was inversely co-related to haemoglobin
levels (p= .01212). Male patients were more likely to be anaemic than female
patients (p= .00001) there was also a significant relationship between level of
blood pressure and haemoglobin level (p=. 00050). The mean left ventricular
mass index was 133.6g/m2 (95% CI 94.3-172). Males were more likely to have
high left ventricular mass indices (p=. 03800). There was a significant inverse
relationship between creatinine clearance and left ventricular mass index (p=.
00047) Similarly, there was a significant inverse co-relation of haemoglobin
level and left ventricular mass index (p<.00001 ).There was a strong
relationship between level of blood pressure and left ventricular mass index
(p=.00003). Multiple regression analysis revealed that the relationships of
Haemoglobin level and Hypertension to left ventricular hypertrophy were
independent of other variables.(p<0.0001 in both cases). 94% of patients had
two or more cardiovascular risk factors.
Conclusions: There is a high prevalence of cardiovascular risk factors,
frequently multiple, in patients with chronic renal insufficiency seen at KNH. A
significant relationship between Anaemia, hypertension and left ventricular
mass index was also demonstrated. | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |