Abstract:
Cardiovascular Disease (CVD) is the
leading cause of mortality in patients with End Stage
Renal Disease (ESRD) globally. Renal replacement
therapy improves the quality of life of these patients
but CVD remains a threat to their survival. Whereas
atherosclerotic coronary artery disease is the leading
culprit in high income countries, this has not been
characterized in Kenya.
Objective: To determine the prevalence and spectrum
of cardiac disease in patients with ESRD undergoing
haemodialysis at Moi Teaching and Referral Hospital
(MTRH), a tertiary medical centre in Western Kenya.
Methods: This was a cross sectional study conducted
at MTRH renal unit. Consenting consecutive adults
with ESRD undergoing chronic heamodialysis were
enrolled into the study after obtaining ethical approval
from the institution’s review board. Data on socio
demographics, medical and drug history was collected
using a structured questionnaire followed by a focused
cardiovascular examination. A standard trans-thoracic
echocardiogram was done by a study dedicated
sonographer and interpreted by a cardiologist using
American Society of Echocardiography guidelines.
A standard 12 lead resting ECG was also done and
read by the same cardiologist. Outcomes of interest
included Left Ventricular Hypertrophy (LVH), Left
Ventricular Ejection Fraction (LVEF), pathological
valve disease, pathological Q waves and arrhythmias.
The prevalence estimates were reported with the
corresponding 95% confidence intervals.
Results: Seventy two participants were included in the
final analysis. Their median age was 41 (29.8, 60) years
and 51.3% were male. Majority (93%) were on two
sessions of dialysis per week, with 97.2% being known
hypertensives. Almost three quarters of them (72.2%)
had some form of cardiac disease as follows; left
ventricular hypertrophy 58%, left ventricular systolic
dysfunction 49%, pathological valvular disease 15.3%,
arrhythmias 9.7% and pathological Q waves 6.9%.
Conclusion: There is a high burden of cardiac disease
in patients with ESRD on heamodialysis at MTRH with
the predominant lesions being LVH and left ventricular
systolic dysfunction.
