Traditional and Non-traditional Cardiovascular Risk Factors in the Chronic Dialysis Population at Chris Hani Baragwanath Academic Hospital and Sebokeng Provincial Hospital

Abstract

Introduction Patients with chronic kidney disease (CKD) are at risk for accelerated cardiovascular disease (CVD). There is evidence for the contribution of traditional and non-traditional risk factors to CVD in CKD. Non-traditional risk factors are under-recognised and poorly managed in CKD. Methods Clinical records for patients 18 years or older on chronic dialysis at two public hospitals in South Africa were retrospectively reviewed. Results There were 147 patients with a mean age of 43.7 years, 53% male and 98% black African in the cohort. The prevalence of hypertension was 85% with a mean systolic blood pressure of 148.0mmHg (±22.8) and a mean diastolic blood pressure of 93.4mmHg (±18.2), implying poor control in this cohort. The prevalence of diabetes mellitus was 5.5% and the mean body mass index was 24.5kg/m2 (±4.5). The prevalence of anaemia was 41% with a mean haemoglobin of 10.6g/dL (±2.4). We found a high mean phosphate of 1.7mmol/L (±0.6), mean calcium of 2.2mmol/L (±0.3) and albumin 38.8g/L (±4.7) in the cohort. Patients on peritoneal dialysis (PD) had higher mean systolic (p=0.028) and diastolic blood pressure (p=0.004) compared to patients on haemodialysis (HD). Patients on PD had higher mean total cholesterol (p=0.001), PTH (p=0.028) and haemoglobin (p=0.015) levels compared to patients on HD. Patients on PD had lower mean albumin (p=0.001) and calcium (p=0.000) levels compared to patients on HD. When stratified by sex or HIV status, no significant differences in cardiovascular risk factors were found, except for a higher prevalence of smoking exposure in male patients. Conclusion In this cohort of mostly black African chronic dialysis patients, there was low prevalence of traditional cardiovascular risk factors except poorly controlled hypertension. We found high prevalence of anaemia and hyperphosphataemia. Those on PD had greater traditional and non- traditional risk factor burden. We recommend longitudinal follow-up studies evaluating effect of risk factor control on CVD outcomes to aid clinicians in managing this higher risk group.