ObjectiveWe assessed left ventricular structural alterations associated with chronic kidney disease (CKD) in Congolese patients with type 2 diabetes.MethodsThis was a cross-sectional study of a case series. We obtained anthropometric, clinical, biological and echocardiographic measurements in 60 consecutive type 2 diabetes patients (37 females, 62%) aged 20 years or older from the diabetes outpatient clinic, University of Kinshasa Hospital, DRC. We computed creatinine clearance rate according to the MDRD equation and categorised patients into mild (CrCl > 60 ml/min per 1.73 m2), moderate (CrCl 30–60 ml/min per 1.73 m2) and severe CKD (< 30 ml/min per 1.73 m2). Left ventricular hypertrophy (LVH) was indicated by a LV mass index (LVMI) > 51 g/m2.7 and LV geometry was defined as normal, or with concentric remodelling, eccentric or concentric hypertrophy, using relative wall thickness (RWT) and LVMI.ResultsCompared to patients with normal kidney function, CKD patients had higher uric acid levels (450 ± 166 vs 306 ± 107 μmol/l; p ≤ 0.001), a greater proportion of LVH (37 vs 14%; p ≤ 0.05) and longstanding diabetes (13 ± 8 vs 8 ± 6 years; p ≤ 0.001). Their left ventricular internal diameter, diastolic (LVIDD) was (47.00 ± 6.00 vs 43.00 ± 7.00 mm; p ≤ 0.001), LVMI was (47 ± 19 vs 36.00 ± 15 g/m2.7; p ≤ 0.05) and proportions of concentric (22 vs 11%; p ≤ 0.05) or eccentric (15 vs 3%; p ≤ 0.05) LVH were also greater. Severe CKD was associated with increased interventricular septum, diastolic (IVSD) (12.30 ± 3.08 vs 9.45 ± 1.94 mm; p ≤ 0.05), posterior wall thickness, diastolic (PWTD) (11.61 ± 2.78 vs 9.52 ± 1.77 mm; p ≤ 0.01), relative wall thickness (RWT) (0.52 ± 0.17 vs 0.40 ± 0.07; p ≤ 0.01) rate of LVH (50 vs 30%; p ≤ 0.05), and elevated proportions of concentric remodelling (25 vs 15%; p ≤ 0.05) and concentric LVH (42 vs 10%; p ≤ 0.05) in comparison with patients with moderate CKD. In multivariable adjusted analysis, hyperuricaemia emerged as the only predictor of the presence of LVH in patients with CKD (adjusted OR 9.10; 95% CI: 2.40–33.73).ConclusionIn keeping with a higher rate of cardiovascular events usually reported in patients with impaired renal function, CKD patients exhibited LVH and abnormal LV geometry.

Objective: To assess the prevalence of prehypertension and hypertension, their determinants and associated cardiovascular risk factors in Congolese urban dwellers. Methods: From July 2007 to March 2008, we collected information on lifestyle habits, medical history and anthropometric data in 1292 household members of Adoula Quarter, Kinshasa, aged 20 years or more, 731 women (56.6%). We obtained measurements of BP, blood glucose, serum lipids and qualitative proteinuria. We defined blood pressure categories according to JNC7 classification and used logistic regression analyses to assess their independent determinants. We obtained age adjustment of continuous and categorical variables using GLM and Genmod procedures, respectively. Results: Prehypertension was observed in 30.3% of subjects, 34.9% of men and 26.7% of women (P = 0.0045). The prevalence of hypertension amounted to 30.9% with no difference between genders. Participants with prehypertension had average age, BMI and waist circumference intermediate between those with normal BP and hypertensive subjects. Their glucose and lipids levels were * Corresponding author. M. P. Bayauli et al. 391similar to those of normotensives. The prevalence of prehypertension amounted to 33% at age 20 -29 years and decreased to 16.7% at ≥60 years whereas the prevalence of hypertension increased from 11.2% to 71.4%. The rates of diabetes mellitus were similar accross blood pressure catogories whilst prevalences of overweight/obesity, abdominal adiposity, dyslipidemia and metabolic syndrome significatively increased (P = 0.05 or less). Among participants with prehypertension, 73% had two or more additional cardiovascular risk factors. In the logistic model the probability of prehypertension was higher in men (OR: 1.429; 95% CI: 1.099 -1.857) and participants with overweight/obesity (OR: 1.666; 1.146 -2.422), lower in participants aged ≥ 55 years (0.427; 0.267 -0.683) and those with high fruit intake (0.691; 0.488 -0.977). The probability of hypertension was higher in participants aged ≥ 55 years (OR: 6.988; 4.561 -10.706), overweight/obesity (2.263; 1.704 -3.004), those with high vegetables consumption (1.152; 1.003 -1.324) and faster pulse rate (1.013; 1.002 -1.025). Conclusion: Our results suggest that fruit consumption and control of overweight are important issues for prevention of cardiovascular disease in sub-Saharan Africa where high blood pressure is the main driver of the current epidemic.

Objective: To assess the LV mass, geometry and systolic function in hypertensive patients with reduced kidney function. Methods: According to ASE guidelines, we estimated LV ventricular mass, geometry and systolic function in 155 consecutive hypertensive patients [51% women, mean age 51 ± 12 years, median duration of hypertension 7 years] with reduced kidney function (eGFR < 60 ml/min/1.73 m 2 or dipstick proteinuria ≥ 1+). LVH was defined as LVMI >125 g/m 2 in men, >110 g/m 2 in non obese women or >51 g/m 2.7 for obese men or women. Where appropriate, we used Student t, Mann Whitney, one way ANOVA or Chi square tests. A P value of 0.05 or less was considered significant. Results: Seventy four patients in the series (48%) had reduced kidney function (eGFR 30 ± 15 ml/min/1.73 m 2 ). Compared to patients with relatively normal kidney function, non obese and obese patients with reduced kidney function had significantly greater LVM [271 (198 -348) vs 276 (175 -284) g/m 2 , p = 0.008] for non obese; LVM 72 (47 -88) vs 54 (44 -73) g/m 2.7 , p = 0.007 for obese] and lower EF (60 ± 14 vs 68 ± 13%, p < 0.001) was significantly lower. LVH of mainly concentric geometric pattern was present in 68 patients with reduced kidney function (92%). Conclusion: In the present case series, reduced kidney function was associated with increased LVM, concentric geometric pattern and impaired systolic function.