Atherosclerotic vascular disease is more prevalent among black ESKD patients on long-term CAPD in South Africa

Abstract

BackgroundOccurrence of cardiovascular disease (CVD) in the setting of chronic kidney disease (CKD) can be described as a “cruel alliance”, with CVD responsible for about half of all deaths among CKD patients. Chronic kidney disease patients are more likely to die from CVD than progress to end stage kidney disease (ESKD). Dyslipidaemia, a known traditional risk factor for CVD, is highly prevalent among CKD patients and with an even higher frequency among ESKD patients on dialytic therapies. Prolonged exposure of continuous ambulatory peritoneal dialysis (CAPD) patients to high glucose concentrations in CAPD fluid have been associated with increased risk of cardiovascular events. In this study, we investigated the relationship of atherosclerotic vascular disease (AsVD) to clinical and echocardiographic parameters among black South Africans with CKD (stage 3) and ESKD on CAPD and haemodialysis (HD).MethodsThis was a cross-sectional study of 40 adult (18–65 years) non-diabetic CKD patients (kidney disease outcome quality initiative [KDOQI] stage 3), 40 ESKD patients on CAPD, 40 ESKD patients on HD and 41 age and sex-matched healthy controls. An interviewer-administered questionnaire was used to obtain information on participants’ sociodemographic and cardiovascular risk factors. Anthropometric parameters were measured. Serum blood samples were analysed for creatinine, albumin and lipid profile; lipoprotein ratios, Framingham’s risk score and the 10-year risk of developing coronary heart disease (CHD) were calculated. Echocardiography was performed on all patients and carotid intima media thickness (CIMT) was measured in both right and left carotid arteries at 1 cm proximal to the carotid bulb. Spearman’s rank correlation and binary logistic regression were conducted to determine the relationship of AsVD to clinical and echocardiographic parameters.ResultsAtherosclerotic vascular disease was most prevalent among ESKD patients on CAPD (70%, n = 28/40). Chronic kidney disease and HD patients exhibited a similar prevalence (47.5%, n = 19/40), while the prevalence in controls was 17.1% (n = 7/41). Presence of AsVD was associated with significantly older age, higher waist hip ratio (WHR), left ventricular mass index (LVMI) and Framingham’s 10-year risk of developing CHD. Significant differences in clinical and echocardiographic parameters were observed when the study groups were compared. Age and LVH independently predicted AsVD.ConclusionAtherosclerotic vascular disease was more prevalent among CAPD patients compared to pre-dialysis CKD and HD patients. Among all lipoprotein ratios assessed, non-HDL-C showed the most consistent significant difference between the groups. Age (> 40 years) and presence of LVH were independent predictors of AsVD.

Cardiovascular disease in chronic kidney disease – a review of risk factors

“…Among black CKD patients receiving care in a tertiary health facility in South Africa, we reported a higher prevalence of carotid atherosclerotic vascular disease (AsVD) in stage 3 CKD and ESKD patients compared to controls. AsVD was more prevalent among peritoneal dialysis (PD) patients compared to haemodialysis (HD) and CKD stage 3 patients [5]. In a previous study, we also reported an increased prevalence of left ventricular hypertrophy (LVH) among kidney transplant recipients compared to controls [6].…”

“…In a previous study, we evaluated the prevalence of AsVD and its predictors among Black patients with stage 3 CKD or ESKD on continuous ambulatory peritoneal dialysis (CAPD) or HD. AsVD was most prevalent among CAPD patients, occurring in 70%, compared to 47.5% among HD patients and 17.1% among controls [5]. Similarly, Go et al [10] reported an association between lower GFR and CVD.…”

MicroRNAs Associated with Chronic Kidney Disease in the General Population and High-Risk Subgroups—A Systematic Review

“…As a result, most affected individuals are unaware of their disease status, and are often only detected at an advanced stage of the disease [ 3 ]. Furthermore, CKD is an independent risk factor for cardiovascular disease (CVD), and individuals with CKD are more likely to die of CVDs than progress to end-stage kidney disease (ESKD) [ 4 ]. Early diagnosis of CKD and effective screening of high-risk individuals is critical to mitigate disease progression and substantially reduce related poor health outcomes [ 5 ].…”