Prevalence and Predictors of Heart Failure among Patients on Maintenance Hemodialysis Therapy at Tertiary Care Hospitals

Abstract

Background and Aim: The incidence of heart failure among hemodialysis patients predicts poor outcomes. Hypertension, aging, and diabetes mellitus are traditional risk factors for heart failure which may not predict heart failure accurately. Heart failure might be caused by other factors. The present study aims to determine the prevalence and predictors of heart failure among patients on maintenance hemodialysis. Methodology: This cross-sectional study was carried out on 142 hemodialysis patients in the department of Cardiology, PNS Shifa Hospital Karachi and King Abdullah Teaching hospital Mansehra for duration of six months from 5th March 2021 to 4th September 2021. All the patients having age above 16 years and who underwent at least three months of dialysis therapy were enrolled. Patients with severe respiratory distress and mentally incapacitated were excluded. Questionnaire-based Pro-forma was used for collecting patient’s demographic details, clinical details such as human immunodeficiency virus (HIV) disease, heart failure symptoms, hyperlipidemia, angina, and presence of diabetes, etc., and dialysis-related clinical information. Stadiometer and standard weight scale were used for height and post-dialysis weight also known as dry weight respectively. A monthly dose of erythropoietin (EPO) was taken from medical records. Based on the blood sample, albumin, ferritin, urea, complete blood count, C-reactive protein (CRP), and total cholesterol were measured. SPSS version 21 was used for data analysis. Results:Out of 142 hemodialysis patients, 105 (73.9%) were male and 37 (26.1%) were females. Overall mean age was 46.74 ± 11.62 years. Of the total 142 patients, the prevalence of hypertension and diabetes mellitus was 138 (97.2%) and 73 (51.4%) respectively. The incidence of heart failure was 21 (14.8%). The incidence of hypertension, anemia, and angina were heart failure autonomousprognosticators on multivariate analysis. A higher score of malnutrition inflammation and resistance index for erythropoietin was found in heart failure patients. Conclusion: Our study found that heart failure is significantly associated with anemia, angina, and hypertension in hemodialysis patients. Malnutrition–inflammation complex and erythropoietin resistance were more prevalent in patients with heart failure. These conditions necessitate a thorough cardiac evaluation and appropriate treatment. Keywords: Heart Failure, Hemodialysis, Hypertension. Angina