A dissertation submitted to the Faculty of Health Sciences, University of
the Witwatersrand, Johannesburg, in fulfillment of the requirements for the
degree of Master of Science in Medicine
Johannesburg, 2005 / ABSTRACT
INTRODUCTION
The risk of cardiovascular disease in patients with end stage renal disease (ESRD) is far
greater than in the general population. Amongst patients with ESRD, the prevalence of
coronary artery disease (CAD) and congestive heart failure is approximately 40%
compared with 5-12% in the general population. The excess risk is caused by multiple
traditional and non-traditional risk factors for ischaemic heart disease present in these
patients. There is little information on CAD and its risk factors in black haemodialysis
patients as most of these studies were carried out in the white population. This study is
therefore aimed at determining the risk factors for atherosclerosis in Black and non-black
(White and Indian) South African patients on haemodialysis.
METHODS
Fifty-eight black patients and twenty-six non-black patients on haemodialysis were
recruited. Sixty-three age and sex matched controls (staff, students and kidney donors)
were also recruited. Fasting venous blood samples were drawn for measurement of Creactive
protein, homocysteine, Lp (a), serum lipids and adiponectin. Carotid intima-media
thickness and plaque occurrence was measured by B-mode ultrasonography.
Echocardiography was used to determine LVH.
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RESULTS
Haemodialysis (HD) patients had significantly lower total cholesterol, LDL cholesterol and
triglycerides compared with controls (p<0.001; p= 0.042). Hs-CRP, adiponectin and
homocysteine levels were significantly higher in patients compared with controls (p<
0.001). The prevalence of plaques was significantly higher among HD patients (32%)
compared with controls (7%) X2 = 60.72 p< 0.001. LVMI was significantly higher among
HD patients (194.25± 7.69gm/m2) compared with controls (93.21 ± 3.27 gm/m2) p < 0.001.
No significant difference between patients (Black or Asian/White) and controls with respect to
CIMT was found. CVD risk factors in black haemodialysis patients and black controls showed a
similar pattern to the whole study population combined. Risk factors associated with CIMT on
regression analysis were total cholesterol, LDL-cholesterol, age, Hs-CRP, family history of
CKD. Risk factors associated with plaque occurrence on logistic regression analysis were
age, systolic blood pressure, male gender, smoking, calcium phosphate product and serum
phosphate.
CONCLUSION
HD patients have a high prevalence of traditional and non-traditional risk factors for
atherosclerosis and this is independent of race. Traditional risk factors like lipids were
much lower in ESRD patients. HD patients showed a high prevalence of atherosclerosis as
measured by increased carotid intima-media thickness and plaque occurrence in carotid
arteries. Hs-CRP correlated significantly with a surrogate marker of atherosclerosis
(CIMT).
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/1606 |
| Date | 08 November 2006 |
| Creators | Amira, Christiana Oluwatoyin |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | 1527604 bytes, application/pdf, application/pdf |
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