Prevalence and types of electrocardiograph abnormalities in dialysis naive chronic kidney disease patients at Kenyatta national hospital

Abstract

Background: Chronic non-communicable diseases (NCDs) contribute to more than 60% of all deaths worldwide and approximately 80% of these deaths occurred in low and middle income countries, a category where Kenya belongs. Chronic Kidney Disease (CKD) is a risk multiplier and is associated with an eight- to tenfold increase in cardiovascular mortality. The presence of cardiac arrhythmias and other electrocardiographic abnormalities is high in CKD patients and this increases the risk for sudden cardiac death which is the single greatest contributor to mortality in advanced renal disease. There is paucity of data in Kenya on the prevalence of ECG abnormalities in dialysis naïve CKD patients. Objectives: The primary aim of this study was to determine the prevalence and types of ECG abnormalities in dialysis naïve CKD patients at Kenyatta National Hospital. The secondary objective was to correlate the ECG abnormalities with the CKD stage Methods: This was a cross-sectional descriptive study carried out at the Kenyatta National Hospital. Patients aged 30 years and above who had a file documented diagnosis of CKD and were dialysis naïve were recruited consecutively. The study was carried out from November 2013 to February 2014. A standard 12 lead resting ECGs was recorded and interpreted by the principal investigator as per the “AHA/ACC recommendations for the standardization and interpretation of the electrocardiogram” and the readings were subsequently confirmed by a consultant cardiologist. Estimation of serum creatinine was done so as to establish the CKD stage. Results: A total of 212 patients were recruited. The mean age of the patients was 54.2 years and 58% were male. Hypertension and diabetes were the main aetiological factors for CKD in more than 80% of the participants. Overall, 64% of the patients had at least one form of ECG abnormality. The proportion of patients who had atrial fibrillation was 16%; premature ventricular contractions at 8%; left ventricular hypertrophy at 29.7%; repolarisation changes at 18.9%; prolonged QT interval at 14.6%. Advanced CKD was associated with abnormal ECG findings and the prevalence of ECG abnormalities increased proportionately to the severity of CKD. Conclusion: The prevalence of ECG abnormalities in our dialysis naïve CKD patients is high and this includes ECG abnormalities that predict adverse cardiovascular morbidity and mortality such as left ventricular hypertrophy, prolonged QT interval and repolarisation changes. Recommendations: An ECG should be recorded and evaluated in all CKD patients and a multidisciplinary approach to these patients is crucial. There is need for more studies to establish the role of serial ECGs in the long term follow-up of CKD patients which may be crucial in the early detection of new ECG changes. In order to establish the prognosis and therapeutic effects of treatment given to CKD patients who have various ECG abnormalities, more follow-up studies are needed.