Abstract
IntroductionCardiovascular disease is the leading cause of morbidity and mortality in patients on maintenance hemodialysis. We investigated the pattern and correlates of cardiac lesions in a group of Cameroonians on chronic hemodialysis.MethodsThis was a cross-sectional study conducted at the Yaoundé General Hospital's hemodialysis unit, involving 45 patients (29 men, 64%) on maintenance hemodialysis for at least three months using a native arterio-venous fistula. Cardiovascular risk factors, biological, electrocardiographic and echocardiographic data were collected.ResultsHypertension (29%), chronic glomerulonephritis (24%) and diabetes mellitus (24%) were the main etiological factors of chronic kidney disease. Blood pressure was controlled in 14 (31%) patients. Nineteen (42%) patients had anemia and 5 (14%) had a calcium-phosphorus product >55 mg2/dl2. All patients had at least one cardiovascular risk factors with hypertension (95%), anemia (42%) and highcalcium-phosphorus product (42%) being the most frequent. Thirty-eight (84%) patients had at least one cardiac lesion and 11 (29%) had three or more lesions. The cardiac lesions were left ventricular hypertrophy (60%), valvular calcifications (38%), heart failure (36%), conduction disorders (33%), pericardial effusion (13%), valvular diseases (11%) and ischemic heart diseases (2%). Left ventricular hypertrophy was significantly associated with a longer duration on dialysis and low hemoglobin level (both p < 0.047) while cardiac failure and valvular calcifications were associated with advanced age and high interdialytic weight gain (both p <0.05).ConclusionCardiac lesions and cardiovascular risk factors are frequent in these patients receiving sub-optimal dose maintenance hemodialysis despite their younger age, suggesting an increased susceptibility to cardiovascular complications.
Highlights
Cardiovascular disease is the leading cause of morbidity and mortality in patients on maintenance hemodialysis
In the remaining 102 patients on maintenance hemodialysis, 16 (15.7%) had less than 3 months duration in dialysis, 19 (18.7%) patients were dialyzed by catheter and 22 (21.6%) patients did not have electrocardiogram and cardiac ultrasound done during annual evaluation
This study conducted in young end stage renal disease patients receiving a lower hemodialysis dose than the standard of care revealed a high prevalence of cardiac lesions led by left ventricular hypertrophy (LVH), valvular calcifications and heart failure
Summary
Cardiovascular disease is the leading cause of morbidity and mortality in patients on maintenance hemodialysis. Conclusion: Cardiac lesions and cardiovascular risk factors are frequent in these patients receiving sub-optimal dose maintenance hemodialysis despite their younger age, suggesting an increased susceptibility to cardiovascular complications. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) [1,2]. The occurrence of LVH and its evolution to cardiomyopathy, cardiac failure, are determined by the high prevalence of traditional and uremia-related cardiovascular risk factors in dialysis patients [3, 4]. During CKD, There is an increased risk of atherosclerosis which is the leading cause of ischemic heart disease in such patients.This is related to the accelerated progression of coronary plaque, greater media thickening and vascular calcification favored by dyslipidemia and mineral bone disease [3,4,5]. Arteriosclerosis is due to large vessel remodeling and loss of elasticity and compliance, leading to increase pulse pressure and hypertension [3, 4, 6]
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