Prevalence and predictors of left ventricular dysfunction among patients with chronic kidney disease attending Muhimbili National Hospital in Tanzania — a cross-sectional study

Abstract

Purpose: Chronic kidney disease (CKD) is prevalent in sub-Saharan Africa and is a significant cause of mortality, which may result from kidney failure or congestive heart failure-a frequent complication of CKD. There is however scarcity of documented literature on the magnitude and associated factors of echocardiographically determined left ventricular (LV) dysfunction among CKD patients in Tanzania. Patients and methods: A prospective cross-sectional study was conducted from May 2014 to January 2015 at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Patients ≥18 years with CKD were consecutively enrolled. Clinical characteristics, cardiovascular risk profiles, and laboratory findings including serum creatinine, urea, hemoglobin, and cholesterol levels were collected. Echocardiography was performed to assess LV function using standard criteria. Results: One hundred and ninety-one CKD patients fulfilled the inclusion criteria. The mean ± SD age was 48 ± 13 years, and 54.5% were men. A total of 98.4% of the patients were hypertensive, and diabetes was present in 22.8% while 97.9% had end-stage renal disease. The prevalence of LV systolic and diastolic dysfunction was 16.2% and 68.6%, respectively. A clinical finding of heart failure was the only independent predictor of LV systolic dysfunction (odds ratio [OR] = 2.9, p = 0.012), while independent predictors of LV diastolic dysfunction were anemia (OR = 4.9, p = 0.01), severe hypertension (OR = 9.2, p = 0.001), and female gender (OR = 1.7, p = 0.002). Conclusion: LV dysfunction is prevalent among CKD patients seen at MNH and is associated with clinical heart failure, anemia, severe hypertension, and female gender. Echocardiography should be performed in patients with CKD to detect overt or subclinical LV dysfunction.

Prevalence and predictors of heart failure among patients on maintenance hemodialysis therapy at Muhimbili National Hospital in Tanzania: a cross-sectional study

“…Compared to those without, patients with HF had a higher median malnutrition inflammation score, and mean erythropoietin resistance index. A lower prevalence of HF was found in our study when compared to an earlier study done at MNH [4]. This may be explained by better fluid volume control as depicted by a high proportion (76.3%) of HD patients in our study receiving adequate dialysis [13].…”

“…Patients on hemodialysis (HD) further succumb to pathological cardiovascular impairment attributed to chronic inflammation, anemia, vascular calcifications, and recurrent fluid volume shifts [2]. In a study done among CKD patients at Muhimbili National Hospital (MNH) in Tanzania, heart failure (HF) was prevalent in 27.7% and was a significant predictor of left ventricular systolic dysfunction [4]. Congestive heart failure was noted in 36% of incident HD patients in a study done in the USA [5].…”

<p>Incidence and Predictors of Congestive Heart Failure Among Hemodialysis Patients at Felege Hiote Referral Hospital, Northwest Ethiopia, 2020: Retrospective Cohort Study</p>

“…This is consistent with studies in the USA 9 and Tanzania. 22 In this study level of education is an important predictor for CHF. Accordingly patients who are unable to read and write were 1.9 times more likely to develop CHF than those who are educated to college level and above (95% CI: 1.9 (5-16.9), p = 0.04).…”

Prevalence, risk factors and predicted risk of cardiac events in chronic kidney disease of uncertain aetiology in Sri Lanka: A tubular interstitial nephropathy

“…Left ventricular (LV) diastolic dysfunction, frequently leading to congestive heart failure is common and almost universal in CKD [ 54 ]. In a study conducted in Tanzania, with 191 participants, recognized that the prevalence of LV diastolic dysfunction in CKD was 68.6% [ 55 ]. Nevertheless, only 5.88% of CKDu patients had LV diastolic dysfunction, and the prevalence was not different between stages.…”