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 180 AFRICA
fold in men who smoke at least 20 cigarettes per day compared to
subjects who never smoked,16 smoking cessation in patients with
CKD should be part of the standard management.
The burden of anaemia demonstrated in this study was
similar to the high burden found in CKD populations elsewhere,
including one done by Gjata et al. in Albania that showed
a 100% frequency,11 and another from Nigeria where a high
proportion of CKD patients with left ventricular hypertrophy
(LVH) were found to be anaemic.10 The high prevalence of
anaemia in all these settings is probably due to the similarity
of pathogenesis, lack of erythropoietin, the most important
factor in anaemia of CKD. Erythropoietin production/secretion
declines with advancing renal failure in all cases of CKD,
regardless of cause, hence the similarity in prevalence across the
different settings. Anaemia in CKD has been associated with
poorer cardiovascular outcomes, including heart failure, LVH
and increased rates of morbidity and mortality.17-19
We observed the prevalence of HIV/AIDS of 14.75% to be
twice that in the general population (7.2%),20 and HIV is a risk
factor for CKD. This makes our study population different from
those in Western countries with less incidence of HIV, suggesting
that HIV/AIDS could be an emerging ‘non-traditional’ risk
factor for CVD.
There were limitations to our study. Our inability to do
renal biopsy meant that analysis for CKD was done as a block
as opposed to clusters according to aetiology. The Cockroft–
Gault formula was used for estimation of GFR instead of the
more accurate MDRD or CKD-EPI methods. This is because
most of the drug dosing is still based on the Cockcroft–Gault
formula, and most doctors in resource-limited settings do not
have access to the internet-based calculation of MDRD and
CKD-EPI, which would have made applicability of our study
findings less desirable. Some biomarkers of poor cardiovascular
outcomes, regarded as non-traditional cardiovascular risk
factors (inflammation, oxidative stress, sympathetic activation,
hyperhomocysteinaemia, and endogenous digitalis-like factors)
were not measured due to resource limitations. The criteria for
evaluating ischaemic heart disease were weak.
Conclusion
This study demonstrated the common occurrence of
cardiovascular risk factors among CKD patients attending
a Ugandan national referral hospital. It also showed that
the prevalence of some of the risk factors (hypertension,
anaemia, hypocalcaemia and hyperphosphataemia) increased
with advancing stage of CKD. Furthermore it indicated late
presentation of patients in advanced renal failure.
Research reported in this publication was supported primarily by the Fogarty
International Center, the National Heart, Lung and Blood Institute, and the
Common Fund of the National Institutes of Health under award number
R24 TW008861, with additional support from the ENRECA project of Gulu
University with funding from DANIDA. The content is solely the responsibil-
ity of the authors and does not necessarily represent the official views of the
National Institutes of Health.
The authors are grateful to the following persons for their invaluable
support: Prof Nelson Sewankambo, Prof Moses R Kamya, Mr Okwakol
George, and the staff of the Mulago central laboratory and the ECG and
Echo laboratories at the Uganda Heart Institute.
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