Cardiovascular Disease Burden in Patients with Non-Dialysis Dependent Chronic Kidney Disease in Cameroon: Case of the Douala General Hospital

Abstract

Introduction: Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Objective: To evaluate the burden of CVD and audit the management of cardiovascular risk factors (CVRF) in patients with non-dialysis (ND) dependent CKD in Cameroon. Patients and Methods: A cross-sectional study in the Douala general hospital was conducted from January to March 2016, including CKD patients’ stages 3 - 5 ND. Socio-demographic data, comorbidities, medications and biological data were extracted from patient’s records. For each participant, lipid profile and urinary protein excretion were measured; a resting electrocardiogram was done. Hypertension, diabetes, dyslipidemia, obesity, smoking, alcohol consumption, anemia, hyperuricemia, proteinuria and high calcium-phosphorus product were considered as CVRF. CVD was defined as a history of stroke, peripheral artery disease, coronary heart disease (CHD), left ventricular hypertrophy (LVH), heart failure (HF) and arrhythmia. We used KDOQI 2003, KDIGO 2012 and JNC 8 guidelines for definition and evaluation of the management of lipid abnormalities, proteinuria and hypertension respectively. Results: A total of 83 patients (45 males) were included; mean age was 56 ± 15 years. Mean number of CVRFs per patient was 5.19 ± 1.64; hypertension (90.3%), obesity (79.5%), anemia (78.3%), dyslipidemia (69.8%) and hyperuricemia (69.8%) were the most frequent. Mean number of CVD per patient was 1.5 ± 0.63 with an overall prevalence of 69.8%; LVH (48.2%) and CHD (30.1%), were the most frequent and prevalence increased significantly with CKD stage. Treatment rate of hypertension was 100%, 53.4% for dyslipidemia and 75.3% for anemia. Target values were achieved in 50% of participants for LDL-cholesterol and phosphorus levels, 26.6% for blood pressure and 6% for hemoglobin levels. Conclusion: CVRF are highly prevalent in non-dialyzed CKD populations in this setting. This may contribute to the burden of CVD implying strict control of these factors.