Pattern and correlates of cardiac lesions in a group of sub-Saharan African patients on maintenance hemodialysis

Abstract

Introduction: Cardiovascular 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.

Methods: This 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.

Results: Hypertension (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 calciumphosphorus 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).

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.

Key words: Cardiac lesions, chronic hemodialysis, Cameroon, Sub-Saharan Africa