Prevalence and pattern of echocardiographic abnormalities among patients with end stage renal disease on Haemodialysis at Mulago National Referal Hospital

Abstract

Background: Cardiovascular disease independent of the primary diagnosis is the most common cause of morbidity and premature mortality in patients on chronic haemodialysis. In Uganda, the prevalence of CKD is almost 16% and there’s an increase in the number of patients on long term haemodialysis for end stage renal disease with the establishment of many haemodialysis centres. There is limited data on cardiac abnormalities among patients in sub-Saharan Africa including Uganda. We determined the prevalence and patterns of echocardiographic abnormalities among patients with end stage renal disease on haemodialysis at Mulago National Referral Hospital in Uganda Methods: This was a cross sectional study with an analytic component in which eighty patients with end stage renal disease on haemodialysis were recruited over a period of five months. Data on demographic characteristics and factors associated with echocardiographic abnormalities were collected using a standardized questionnaire. Cardiac evaluation was done using a transthoracic echocardiography performed for all study participants and findings entered into a data sheet, entered into EpiData and STATA and analysed using multiple logistic regression. Results: Fifty three (66.2%) of the 80 patients were male and mean age was 49years. Seventy four patients (92.5%) had at least one cardiac echo abnormality and twenty four (30%) had at least three abnormalities. Left ventricular hypertrophy (67.5%, 54/80) and diastolic dysfunction (63.8%, 51/80) were the most common echo abnormality patterns. Patients with LVH were more likely to be male (p= 0.022). They were also likely to be diabetic or anaemic although these two associations were not stastistically significant (p= 0.628, p=0.760 respectively). Patients with diastolic dysfunction were more likely to have been on haemodialyis for a period of at least six months (p= 0.041) and were more likely to anaemic but this association was not stastistically significant (p=0.926). The other echo findings were; valvular lesions (43.8%), pericardial effusion (16.2%), systolic dysfunction (10%) and ischemic heart diseases (1.3%). Conclusion: Majority of patients with ESRD on haemodialysis at MNRH have at least one echocardiographic abnormality with the most common being LVH and diastolic dysfunction. Patients on haemodialysis at MNRH should have echocardiography as a routine investigation to detect these abnormalities and help in decisions on management.