Cardiac Function in an African Dialysis Population with a Low Prevalence of Pre-Existing Cardiovascular Disease

Figures & data

Table 1 Causes of end stage renal disease (ESRD), n = 202

Cause of ESRD	n (%)
Hypertension	165 (81.6)
Glomerulonephritis	11 (5.4)
Diabetes	8 (4.0)
Obstruction	4 (2.0)
Polycystic kidney disease	4 (2.0)
Congenital	3 (1.5)
Chronic pyelonephritis	2 (1.0)
Systemic lupus erythematosus	2 (1.0)
Scleroderma	1 (0.5)
Amyloid	1 (0.5)
Hemolytic uremic syndrome	1 (0.5)

Table 2 Causes of death in all dialysis patients and those with echocardiograms

Cause of death	All n = 39 (%)	With echo n = 14 (%)	No echo n = 25 (%)
BP/volume/CVA	4 (10.2)	2 (14.3)	2 (8.0)
Sepsis/TB	16 (41.0)	6 (42.9)	10 (40.0)
Access-related, non-infectious	5 (12.8)	2 (14.3)	3 (12.0)
Withdrew/non-compliance	5 (12.8)	1 (7.1)	4 (16.0)
Other (myeloma, post-transplant, bowel obstruction, bleed, unknown)	9 (23.1)	3 (21.4)	6 (24.0)

*Abbreviations: BP = blood pressure, CVA = Cerebrovascular accident, TB = tuberculosis.

Table 3 Demographic and clinical data on patients in whom echocardiograms were available

Variable	n	All	HD (n = 77)	PD (n = 55)	p value^#
Age in years	132	41.71 ± 10.1	42.3 ± 9.7	42.1 ± 10.1	NS
Gender (M/F)	132	74/58 (56.1/43.9)	45/31 (59.2/40.8)	29/27 (51.8/48.2)	NS
Dialysis vintage at time of echo (months)	132	12 (1–204)	15 (1–204)	6 (1–144)	0.002
Hemoglobin (g/dl)	116	8.9 ± 2.0	8.3 ± 1.7	9.8 ± 2.1	<0.001
Albumin (g/l)	111	35.3 ± 7.9	35.9 ± 3.8	33.1± 6.39	0.004
Calcium (mmol/l)	111	2.4 ± 0.2	2.4 ± 0.3	2.4 ± 0.2	NS
PO4 (mmol/l)	111	1.3 ± 0.7	1.2 ± 0.7	1.4 ± 0.6	NS
Parathyroid hormone (pg/ml)	81	277.7 ± 316	287 ± 350	262 ± 278	NS
Systolic blood pressure (mmHg)	67	149.7 ± 30.7	155.3 ± 26.0	139.0 ± 36.3	0.038
Diastolic blood pressure (mmHg)	67	83.4 ± 16.7	85.4 ± 14.6	79.4 ± 19.7	NS
Cholesterol (mmol/l)	110	4.1 ± 1.0	3.9 ± 1.0	4.6 ± 1.0	<0.001
Latest EF (%)	132	63.2 ± 11.2	63.8 ± 11.5	62.4 ± 10.7	NS

All data expressed as means ± SD except *dialysis vintage at time of latest echo expressed as median (range) and gender as n (%).

^#The p value for comparisons between HD vs. PD; NS; Not Significant.

Table 4 Ejection fraction and LVH by dialysis vintage (n = 132)

Vintage	0–12 mo n = 71 (%)	13–24 mo n = 21 (%)	24–60 mo n = 22 (%)	>60 mo n = 18 (%)	p value
HD/PD	37/34 (52.1/47.9)	8/13 (38.1/61.9)	17/5 (77.3/22.7)	15/3 (83.3/16.7)	0.006
Mean EF (%)	63.6 ± 10.0	61.3 ± 10.4	62.1 ± 13.6	65.2 ± 13.2	NS
EF
<50%	7 (9.9)	4 (19.0)	3 (13.6)	2 (11.1)	NS
50–70%	47 (66.2)	13 (61.9)	14 (63.6)	7 (38.9)
>71%	17 (23.9)	4 (19.0)	5 (22.7)	9 (50.0)
LVH
Yes	54 (76.1)	15 (71.4)	15 (68.2)	16 (88.9)	NS
No	8 (11.3)	0 (0)	1 (4.5)	0 (0)
Unknown	7 (9.9)	6 (28.6)	5 (22.7)	1 (5.6)
Dilated	2 (2.8)	1 (4.8)	1 (4.5)	1 (5.6)	NS
Hemoglobin (g/dl)	9.1 ± 1.9	8.8 ± 2.1	8.7 ± 2.6	8.5 ± 1.9	NS
Albumin (g/l)	35.7 ± 9.5	31.4 ± 5.7	35.8 ± 3.7	37.3 ± 4.1	NS
Intact PTH (pg/ml)	241.7 ± 292.5	166.9 ± 221.8	341.5 ± 299.0	453 ± 416	NS
Systolic BP (mmHg)	144.2 ± 29.2	141.7 ± 27.1	157.0 ± 33.5	168.1 ± 30	NS
Diastolic BP (mmHg)	81.2 ± 18.1	80.3 ± 17.8	84.4 ± 14	91.5 ± 12.4	NS

All data expressed as means ± SD or n (%). NS: Not Significant.

Figure 1. Scattergram of ejection fraction (EF) versus time from initiation of dialysis in 132 dialysis patients. Systolic dysfunction was defined as an EF < 50%.

Table 5 Comparison between patients who died or survived

	Died (n = 14)	Alive (n = 118)	p value
EF
<50%	1 (7. 1%)	15 (12.7%)	0.023
50–70%	5 (35.7%)	76 (64.4%)
>70%	8 (57.1%)	27 (22.9%)
LVH:
Yes	14 (100%)	87 (73.7%)	ND
No	0	10 (8.5%)
Unknown/dilated	0	21 (17.8%)
HD/PD	9/5	68/50	NS
Hemoglobin (g/dl)	7.9 ± 1.6	9.1 ± 2.1	NS
Albumin (g/l)	34.8 ± 5.6	35.4 ± 8.2	NS
Calcium (mmol/l)	2.4 ± 0.3	2.4 ± 0.2	NS
Phosphate (mmol/l)	1.4 ± 0.7	1.3 ± 0.7	NS
Parathyroid hormone (pg/ml)	408.1 ± 504.7	263.4 ± 290.0	NS
Systolic blood pressure (mmHg)	158.9 ± 32.8	148.1 ± 30.3	NS
Diastolic blood pressure (mmHg)	85.5 ± 15.2	83.0 ± 17.1	NS
ACE inhibitors	4	60	NS
β-blockers	5	44	NS

*The p value for comparisons between alive vs. ciled. NS: Not Significant ND: numbrs too small for analysis.