Cardiovascular profile of patients with chronic kidney disease
Keywords:Anaemia, Cardiovascular disease, Chronic kidney disease, End-stage renal disease, Hypertension
Background: Frequency of fatal and nonfatal cardiovascular events increase even in early stages of chronic kidney disease (CKD). This study was aimed to understand the cardiovascular profile of patients with CKD.
Methods: This observational study was conducted on patients who were admitted with chronic kidney disease in Sri Venkateswara Rama Narayan RUIA Government General Hospital, Tirupati. Patients were classified according to their severity of CKD. All patients had an electrocardiogram and echocardiogram. Results of various biochemical investigations, electrocardiogram and echocardiogram were compared between patients with mild, moderate and severe CKD.
Results: Combined diabetes mellitus and hypertension was found to be the most common case of CKD in Authors patient population (43%), followed by diabetes mellitus alone (37%). Serum creatinine and blood urea nitrogen were found to be significantly higher and creatinine clearance and haemoglobin were significantly lower among patients with severe CKD. Electrocardiography revealed 50% had left ventricular hypertrophy (LVH), 30% had tall ‘T’ waves and 15 % had ST-segment changes. Mean inter-ventricular septal end diastole thickness and mean left ventricular mass was found to be significantly in patients with severe CKD as compared to mild CKD.
Conclusions: Extensive cardiovascular evaluation of patients with CKD is warranted even if the classical symptoms are not absent and early cardiovascular rehabilitation should be instituted in such patients.
Bright R. Reports of Medical Cases selected with a view of illustrating the symptoms and cure of diseases by a reference to morbid anatomy. London: Logmans. Med Chir Rev.1831;15(30):289-330.
Ritz E. Minor renal dysfunction: an emerging cardiovascular risk factor. Heart. 2003;89(9):963-4.
Culleton BF, Larson MG, Wilson PW, Evans JC, Parfrey PS, Levy D. Cardiovascular disease and mortality in a community- based cohort with mild renal insufficiency. Kidney Int. 1999;56(6):2214-9.
Shulman NB, Ford CE, Hall WD, Blaufox MD, Simon D, Langford HG, et al. Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the Hypertension Detection and Follow-up Program. The Hypertension Detection and Follow- up Program Cooperative Group. Hypertension. 1989;13(Suppl 5):1180-93.
Ferguson JF, Matthews GJ, Townsend RR, Raj DS, Kanetsky PA, Budoff M, et al. Candidate gene association study of coronary artery calcification in chronic kidney disease: findings from the CRIC study (Chronic Renal Insufficiency Cohort). J Am Coll Cardiol. 2013;62(9):789-98.
Cockcroft DW, Gault H. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57(6):450-8.
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139(2):137-47.
Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, et al. Clinical and echocardiographic disease in patients starting end stage renal disease therapy. Kidney Int. 1995;47(1):186-92.
London GM, Drueke TB. Atherosclerosis and arteriosclerosis in chronic renal failure. Kidney Int. 1997;51(6):1678-95.
London GM, Pannier B, Marchais SJ, Guerin AP. Calcification of the aortic valve in the dialyzed patient. J Am Soc Nephrol. 2000;11(4):778-83.
Lewington S, Clarke R, Qizilblash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality; a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903-13.
Danesh J, Lewington S, Thompson SG, Lowe GD, Collins R, Kostis J, et al. Plasma fibrinogen level and risk of major cardiovascular diseases and nonvascular mortality: an individual participant metaanalysis. JAMA. 2005;294(14):1799-809.
Chen C, Sung KT, Shih SC, Liu CC, Kuo JY, Hou CJ, et al. Age, gender and load-related influences on left ventricular geometric remodeling, systolic Mid-Wall function, and NT-ProBNP in asymptomatic Asian population. PLoS One. 2016;11(6):e0156467.