Higher Prevalence of Left Ventricular Hypertrophy and Dysfunction in Haemodialysis Patients Compared with Peritoneal Dialysis at A Single Centre in South Africa

Résumé

Background: Abnormalities of cardiac function and structure are highly prevalent among end-stage kidney disease (ESKD) patients and contribute significantly to the high morbidity and mortality seen in these patients. Left ventricular hypertrophy (LVH) is one of the commonest abnormalities and is associated with an increased risk for cardiac events. We studied the prevalence, patterns, and risk factors for LVH among black African patients on dialysis.  

Methods: This was a cross-sectional study conducted at Charlotte Maxeke Johannesburg Academic Hospital. Echocardiography was performed on consecutive patients receiving haemodialysis (HD) and those receiving continuous ambulatory peritoneal dialysis (PD) according to standard guidelines. LVH was diagnosed according to Framingham criteria.

Results: A total of 128 patients were studied; 84 were on HD, while 44 received PD. The prevalence of LVH was significantly higher among the HD patients [73 (86.9%)] compared with the PD patients [30 (68.2%)]; p = 0.011. In addition, HD patients had a higher frequency of concentric LVH (p = 0.004) while left ventricular concentric remodelling was more frequently seen in PD patients (p = 0.023). Diastolic dysfunction was more common in HD patients (64.3%) compared with PD patients (45.5%); p = 0.041. Risk factors associated with LVMI among PD patients were anaemia (p = 0.020),, male gender (p = 0.009) and systolic BP (p< 0.001).

Conclusion: Abnormalities of cardiac structure and function are common among ESKD patients on dialysis. Therefore, echocardiography should form part of the assessment of these patients for early detection and commencement of appropriate treatment to reduce cardiovascular morbidity and mortality.

Keywords: Left ventricular hypertrophy, Haemodialysis, Continuous ambulatory peritoneal dialysis.