Prevalence and predictors of left ventricular dysfunction among patients with chronic kidney disease attending Muhimbili National Hospital in Tanzania — a cross-sectional study

Abstract

Purpose: Chronic kidney disease (CKD) is prevalent in sub-Saharan Africa and is a significant cause of mortality, which may result from kidney failure or congestive heart failure – a frequent complication of CKD. There is however scarcity of documented literature on the magnitude and associated factors of echocardiographically determined left ventricular (LV) dysfunction among CKD patients in Tanzania. Patients and methods: A prospective cross-sectional study was conducted from May 2014 to January 2015 at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Patients ≥ 18 years with CKD were consecutively enrolled. Clinical characteristics, cardiovascular risk profiles, and laboratory findings including serum creatinine, urea, hemoglobin, and cholesterol levels were collected. Echocardiography was performed to assess LV function using standard criteria. Results: One hundred and ninety-one CKD patients fulfilled the inclusion criteria. The mean ± SD age was 48 ± 13 years, and 54.5% were men. A total of 98.4% of the patients were hypertensive, and diabetes was present in 22.8% while 97.9% had end-stage renal disease. The prevalence of LV systolic and diastolic dysfunction was 16.2% and 68.6%, respectively. A clinical finding of heart failure was the only independent predictor of LV systolic dysfunction (odds ratio [OR] = 2.9, p = 0.012), while independent predictors of LV diastolic dysfunction were anemia (OR = 4.9, p = 0.01), severe hypertension (OR = 9.2, p = 0.001), and female gender (OR = 1.7, p = 0.002). Conclusion: LV dysfunction is prevalent among CKD patients seen at MNH and is associated with clinical heart failure, anemia, severe hypertension, and female gender. Echocardiography should be performed in patients with CKD to detect overt or subclinical LV dysfunction.