Cardiovascular Journal of Africa: Vol 26 No 4 (July/August 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 4, July/August 2015 AFRICA 177
Cardiovascular risk factors among patients with chronic
kidney disease attending a tertiary hospital in Uganda
Christopher Babua, Robert Kalyesubula, Emmy Okello, Barbara Kakande, Elias Sebatta,
Michael Mungoma, Charles Kiiza Mondo
Abstract
Introduction: Chronic kidney disease (CKD) is a risk factor
for the development of cardiovascular disease, which is the
primary cause of morbidity and mortality in patients with
CKD. Local data about cardiovascular risk factors among
CKD patients is generally scanty.
Objective: To determine the prevalence of the common cardio-
vascular risk factors among patients with CKD attending the
nephrology out-patient clinic in Mulago national referral
hospital in Uganda.
Methods: This was a cross-sectional study in which 217
patients with a mean age of 43 years were recruited over a
period of nine months. Data on demographic characteris-
tics, risk factors for cardiovascular disease, complete blood
count, renal function tests/electrolytes, and lipid profiles were
collected using a standardised questionnaire.
Results: One hundred and eleven (51.2%) of the participants
were male. Hypertension was reported in 90% of participants
while cigarette smoking was present in 11.5%. Twenty-two
participants (10.2%) were obese and 16.1% were diabetic. A
total of 71.9% had a haemoglobin concentration < 11 g/dl,
with the prevalence of anaemia increasing with advancing
renal failure (p < 0.001); 44.7% were hypocalcaemic and
39.2% had hyperphosphataemia. The prevalence of abnor-
mal calcium and phosphate levels was found to increase with
declining renal function (p = 0.004 for calcium and p < 0.001
for phosphate).
Conclusion: This study demonstrated that both traditional
and non-traditional cardiovascular risk factors occurred
frequently in patients with CKD attending the nephrology
out-patient clinic at Mulago Hospital.
Keywords: CVD risk factors, chronic kidney disease
Submitted 27/10/13, accepted 12/4/15
Cardiovasc J Afr 2015; 26: 177–180
DOI: 10.5830/CVJA-2015-045
Cardiovascular disease is the primary cause of morbidity and
premature mortality in chronic kidney disease patients. 1,2 The
high risk of cardiovascular morbidity and mortality in end-stage
renal disease (ESRD) is a well-established fact.3 However a high
rate of both fatal and non-fatal cardiovascular events has been
observed in patients with earlier stages of chronic kidney disease
(CKD).4 Most of the current guidelines now regard CKD as a
cardiovascular risk equivalent.5
Traditional cardiovascular risk factors, those risk factors
that predict ischaemic heart disease outcomes in the general
population, have been reported to occur commonly in
patients with CKD.5-7 These include hypertension, cigarette
smoking, diabetes, dyslipidaemia and older age. The number of
cardiovascular risk factors appears to correlate with the severity
of kidney dysfunction.7
Non-traditional cardiovascular risk factors are CKD related
and increase in frequency as renal function declines. They are
thought to contribute to the cardiovascular risk excess in CKD
patients compared with the general population.3 These factors
include anaemia, abnormal calcium/phosphorus metabolism,
malnutrition, hypo-albuminaemia, hyperhomocysteinemia,
inflammation, oxidant stress, insulin resistance, altered renin–
angiotensin axis and endothelial dysfunction.8
Despite the fact that cardiovascular diseases are a major
cause of morbidity and mortality in patients with CKD, data on
cardiovascular risk factors among CKD patients are generally
lacking from low-resource countries such as conducted
a study to determine the prevalence of the known cardiovascular
risk factors among patients with CKD attending Mulago Hospital,
a tertiary healthcare facility and university teaching hospital.
Methods
We conducted a cross-sectional study between June 2012 and
February 2013 at Mulago Hospital in Kampala, Uganda. The
hospital also doubles as the teaching hospital for Makerere
University’s College of Health Sciences and serves the 33 million
people of Uganda as well as referrals from the neighbouring
Eastern Democratic Republic of Congo and the Republic of
Southern Sudan.
We consecutively recruited a total of 217 adults with CKD,
aged 18 years and older. CKD was defined as kidney damage
for three or more months, as confirmed by kidney biopsy or
proteinuria, with or without a decrease in glomerular filtration
rate (GFR); or GFR < 60 ml/min/1.73 m2 for three or more
months, with or without kidney damage.1 Patients who had
had any form of renal replacement therapy (haemodialysis,
peritoneal dialysis or renal transplant) were excluded from
the study. Ethical approval was obtained from the School of
Medicine Research and Ethics Committee of the College of
Health Sciences, Makerere University.
Department of Medicine, Gulu University, Gulu, Uganda
Christopher Babua, MB ChB, MMed
Department of Medicine, College of Health Sciences,
Makerere University, Kampala, Uganda
Robert Kalyesubula, MB ChB, MMed
Emmy Okello, MB ChB, MMed
Barbara Kakande, MB ChB, MMed
Elias Sebatta, MB ChB, MMed
Michael Mungoma, MBChB, MMed
Charles Kiiza Mondo, MB ChB, MMed, PhD,