Echocardiographic assessment of cardiac functions in patients of chronic kidney disease stage v on hemodialysis

Abstract

Introduction: Chronic kidney disease (CKD) is emerging to be an important chronic disease globally due to rapidly increasing worldwide incidence of diabetes and hypertension. It encompasses a spectrum of pathophysiologic processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate (GFR). The cardiovascular mortality in these individuals is 10to20fold more frequent than in the general population.Our study assess the pattern of echocardiographic changes in patients of CKD stage V on hemodialysis.
Method: This was a cross sectional study conducted on 100 patients with CKDstage V on maintenance hemodialysis for more than 3 months. All patients were subjected to detailed clinical examination and investigation like complete blood count, renal function tests, liver function tests, lipid profile, ECG, chest X ray PA view and echocardiography.
Results: Out of 100 cases, 58% were males and 42% females, most of them aged above 40 years with hypertension (61%) and diabetes (25%) as leading associated comorbidities. The presenting chief complaints were easy fatiguability (90%), nausea/vomiting (53%), dyspnoea (38%), edema (23%), decreased urine output (23%) and chest pain (10%), associated with pallor (51%), raised JVP (30%) and pedal edema (25%). ECG revealed ST-T changes (34%) as the most common finding, followed by sinus tachycardia (28%), LV hypertrophy (23%), other chambers abnormalities, conduction abnormalities and rhythm abnormalities. In Echocardiography, most common finding was diastolic dysfunction seen in 73% cases, followed by concentric left ventricular hypertrophy (54%), systolic dysfunction (25%), left ventricular enlargement (20%), global hypokinesia (15%), regional wall motion abnormalityof left ventricle (10%), ventricular ectopics (12%), atrial fibrillation (8%), pericardial effusion (7%), aortic valve calcification (29%), mitral regurgitation (39%), mitral valve calcification (8%) and pulmonary arterial hypertension (42%).
Conclusion: The high association of diastolic dysfunction, left ventricular hypertrophy and systolic dysfunction on echocardiography implies that patients of CKD stage V on maintenance hemodialysis require routine echocardiography in all, despite absence of cardiac symptoms, so that timely efforts targeted at prevention and control of left ventricular hypertrophy and systolic dysfunction should be implemented asearlyas possible which may reduce cardiovascular mortality and morbidity in these patients.