Assessment of some cardiovascular risk factors in predialysis chronic kidney disease patients in Southern Nigeria

Abstract

Background:Cardiovascular risk factors are responsible for cardiovascular disease and rapid progression of chronic kidney disease (CKD) to end-stage renal disease. Prompt evaluation, modification, and treatment of these factors in predialysis patients will reduce morbidity and mortality. This study assessed some cardiovascular risk factors in predialysis CKD patients in a tertiary hospital in Southern Nigeria.Patients and Methods:This was a case–control study that involved 76 consecutive predialysis CKD patients and 38 age-and sex-matched controls without CKD over 1 year period. Both groups were assessed for cardiovascular risk factors, and comparisons were made. A P value of <0.05 was taken as significant.Results:The mean ages of the CKD versus control group were 48.00 ± 15.28 versus 45.34 ± 15.35 years. The male:female ratio was 1.7:1 for both groups. The common etiologies of CKD in this study were hypertension 30 (39.5%), diabetes mellitus 23 (30.3%), and chronic glomerulonephritis 19 (25%). There were 38 (50%) in CKD stage 3, 31 (40.8%) in CKD stage 4, and 7 (9.2%) in CKD stage 5. The common cardiovascular risk factors found in the CKD versus control were hypertension (96.1% vs. 42.1%), anemia (96.1% vs. 23.7%), left ventricular hypertrophy (77.6% vs. 23.7%), dyslipidemia (67.1% vs. 39.5%), hypocalcemia (60.1% vs. 18.5%), hyperphosphatemia (63.2% vs. 0%), and hyperuricemia (57.9% vs. 15.8%). These risk factors were significantly higher in CKD group. Hyperphosphatemia and hypoalbuminemia significantly increased across CKD stages 3–5. Anemia was significantly more common in males whereas dyslipidemia was more common in female CKD patients.Conclusion:Cardiovascular risk factors were highly prevalent in predialysis CKD subjects even in early stages. Hypoalbuminemia and hyperphosphatemia significantly increased across the CKD stages 3–5 whereas anemia and dyslipidemia showed significant gender differences. Cardiovascular risk factors should be treated early in predialysis CKD patients.

Cardiovascular Risk Factors in Pre-dialysis Chronic Kidney Disease patients of Nepal

“…Hyperuricemia is also considered to be a risk factor for CVD events and all-cause mortality. 21 The prevalence of hyperuricemia in present study (71%) is much higher than reported prevalence of 57.9% in pre-dialysis CKD patients by Adejumo et al 31 and there is no significant difference in hyperuricemia among the stages of CKD in both the studies. Studies have shown that the risk of CVD events and all-cause mortality increases by about 10% with every mg/dl rise in uric acid.…”

“…39 Significant reduction of serum albumin from stage 3 to 5 predialysis CKD patients observed in present study (p<0.03) is similar to other studies in abroad 9 and in Nepal. 12 However, hypoalbuminemia, a marker of malnutrition, found in 93% of our study population with no difference between the CKD stages contradicts the prevalence of 35.5% reported from Nigeria by Adejumo et al 31 with significant increase of hypoalbuminemia from CKD stage 3 to stage 5.…”

“…Similarly, the prevalence of hypertension (96.1%), dyslipidemia (67.1%) and diabetes (30.3%) in pre-dialysis CKD in Nigeria also showed no difference between CKD stages and their patients were much younger (48.00±15.28 years). 31 Comparison of the occurrence of other traditional risk factors like smoking, obesity, male gender, history of CVD and LVH individually and in totality in the present study, a higher prevalence of traditional risk factors was observed in Stage 3 CKD but the difference between the stages was insignificant. This finding was supported by a study reported from China by Zhang et al 32 which depicts occurrence of increased traditional CVD risk factors even in individuals with mildly decreased eGFR.…”

“…12 However, the prevalence of hyperphosphatemia was much lower (42%) in our study than reported before from Nepal (63.6%) 12 and abroad (63.2%). 31 The lower prevalence of hyperparathyroidism affecting only 12% of CKD stage 5 in our study compared to 55.1% in Japanese CKD population 9 might be because of the cut off levels of parathyroid hormone used for risk stratification. The present study defined hyperparathyroidism as CVD risk only if iPTH was >600pg/ml whereas Iimori et al9 had defined it to be >65pg/ml.…”

Construction and expression of recombinant uricase‑expressing genetically engineered bacteria and its application in rat model of hyperuricemia

“…It was observed from previous studies that approximately two-thirds of uric acid in the human body is excreted by the kidneys, and one-third is excreted by intestinal microorganisms following degradation (24)(25)(26)(27)(28). due to the limited water-solubility of uric acid, increasing the level of uric acid excretion in the kidneys will increase the burden on the organ and lead to renal diseases (29,30). Furthermore, recombinant uricase has been used to convert uric acid into allantoin in the human body in order to decrease the levels of uric acid, but its clinical application is limited due to its side effects, including immunogenicity of heterologous proteins (31,32).…”