Evaluation of Cardiac Abnormalities in Chronic Kidney Disease Utilising Echocardiography: A Study of 54 Patients

Muthu Kumar, P (2007) Evaluation of Cardiac Abnormalities in Chronic Kidney Disease Utilising Echocardiography: A Study of 54 Patients. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: In health the volume and composition of body fluids vary within normal limits and the kidneys are largely responsible for maintaining this state. The kidneys also subserve a host of metabolic and endocrine functions. Chronic kidney disease is a pathophysiological process with multiple etiologies, resulting in inexorable attrition of nephron number and function leading to end stage renal disease. End stage renal disease is a clinical condition in which there has been an irreversible loss of endogenous renal function, of a degree sufficient to render the patient permanently dependent upon renal replacement therapy. Cardiovascular disease is emerging as the most common cause of death in patients with end stage renal disease. The age adjusted cardiovascular complications and mortality is about 30 times higher in end stage renal disease than in general population. Pre transplant cardiovascular disease is also a risk factor for post transplant cardiovascular disease. Besides the traditional risk factors like age, gender, etc there are many risk factors specific to chronic kidney disease like anemia, hyperparathyroidism, hyperhomocysteinemia, proteinuria, hypoalbuminemia, activated renin angiotensin system which contribute to cardiovascular disease. Angina pectoris, myocardial infarction, dysrhythmia, cardiac failure, stroke and peripheral vascular disease are common in end stage renal disease. Cardiomyopathy, whether clinically silent or not, is an independent predictor of cardiac morbidity and mortality. Natural history studies suggests that (1) cardiomyopathy predisposes to cardiac failure and death, and (2) ischemic heart disease results from and predisposes to cardiomyopathy, cardiac failure and death. An understanding of the pathophysiology of cardiovascular diseases in chronic kidney disease enables prevention, early diagnosis and prompt interventions to control the complications. This study done at Stanley Medical College, Chennai identifies the cardiovascular changes and complications found in patients with chronic kidney disease. AIM OF THE STUDY: 1. To study the cardiac changes and complications in patients with chronic kidney disease. 2. To study the incidence of left ventricular dysfunction, concentric left ventricular hypertrophy, pericardial effusion in chronic kidney disease patients using echocardiography. MATERIALS AND METHODS: The study was conducted in patients with chronic kidney disease admitted in Stanley Medical College Hospital during the period August 2005 to September 2006. Inclusion Criteria: The following criteria were used in selection of cases: 1. Patients who were known chronic kidney disease patients. 2. Patients who were symptomatic for 3 months or more. 3. Patients with serum creatinine more than 3 mg% and creatinine clearance <30 ml/min. 4. Patients with bilateral contracted kidneys on abdominal ultra sonogram with poor corticomedullary differentiation and type 2 or type 3 parenchymal changes. Patients with Autosomal Dominant Polycystic Kidney Disease and Obstructive Nephropathy were also included in the study though they did not have contracted kidney due to the underlying disorder. Exclusion Criteria: 1. Patients who were known valvular heart disease, coronary heart disease, diabetes mellitus,etc.. 2. Patients who were known hypertensive for years before the onset of chronic kidney disease. 3. Patients who underwent dialysis after admission. 4. Patients above 50 years of age. 5. Patients who were alcoholics. In all patients, a detailed history was taken, with special interest to the duration of symptoms was noted. Cardiovascular symptoms, like dyspnoea, chest pain, pedal edema, pallor were noted. Blood pressure was measured thrice and the average was taken. Cardiovascular examination was done. Complete hemogram, blood urea, serum creatinine, serum electrolytes, serum calcium, phosphorus and uric acid, serum lipid profile were measured. Patients were also subjected to abdominal ultra sonogram and chest X-ray. SUMMARY: • The study included a total of 54 patients with chronic kidney disease. There were 40 males and 14 females. Mean age was 30 years. • Pedal edema, dyspnoea and chest pain were the common symptoms. 75% had symptoms more than 6 months. • Severe anemia occurred in 40%. • About 94.5% had serum Creatinine more than 5 mg/dl. • About 68.5% had stage 5 chronic kidney disease (Creatinine clearance < 15 ml/min). • Normal chest X-Ray finding was present in 72.3%. • ECG revealed LVH with pressure overload pattern in 18.5%. Low voltage complexes was seen in 3.7%. • Echocardiography - pericardial effusion (46.3%) and concentric LVH (44.4%) were the common abnormalities. Dilated LV occurred in 25.9%, diastolic dysfunction in 27.8% and systolic dysfunction in 20.4%. CONCLUSION: 1. Echocardiography is easily performed, non-invasive, safe, reproducible and accurate in assessment of cardiac function in chronic kidney disease. 2. Pericardial effusion followed by concentric left ventricular hypertrophy were the commonest abnormalities in chronic kidney disease. 3. In Echocardiography, pericardial effusion occurred in 46.3%, concentric LVH in 44.4%, dilated LV in 25.9%, diastolic dysfunction in 27.8% and systolic dysfunction in 20.4%. 4. Echocardiography is more sensitive in diagnosing pericardial effusion and left ventricular hypertrophy than by X-Ray and ECG. 5. Echocardiographically detectable mild pericardial effusion and concentric left ventricular hypertrophy were present in asymptomatic patients. Hence this necessitates screening of patients without cardiac symptoms for cardiac abnormalities immediately after the diagnosis of chronic kidney disease has been made.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cardiac Abnormalities ; Chronic Kidney Disease ; Echocardiography ; Study of 54 Patients.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 04:22
Last Modified: 24 Mar 2018 06:34
URI: http://repository-tnmgrmu.ac.in/id/eprint/6453

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