Burden of Cardiac Disease among Patients Undergoing Chronic Haemodialysis at Moi Teaching and Referral Hospital, Eldoret, Kenya

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.