CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 2, March 2012
AFRICA
73
Left ventricular hypertrophy and geometry in type 2
diabetes patients with chronic kidney disease.
An echocardiographic study
MP BAYAULI, FB LEPIRA, PK KAYEMBE, JR M’BUYAMBA-KABANGU
Abstract
Objective:
We assessed left ventricular structural alterations
associated with chronic kidney disease (CKD) in Congolese
patients with type 2 diabetes.
Methods:
This was a cross-sectional study of a case series.We
obtained anthropometric, clinical, biological and echocar-
diographic measurements in 60 consecutive type 2 diabetes
patients (37 females, 62%) aged 20 years or older from the
diabetes outpatient clinic, University of Kinshasa Hospital,
DRC. We computed creatinine clearance rate according
to the MDRD equation and categorised patients into mild
(CrCl
>
60 ml/min per 1.73 m
2
), moderate (CrCl 30–60 ml/
min per 1.73 m
2
) and severe CKD (
<
30 ml/min per 1.73 m
2
).
Left ventricular hypertrophy (LVH) was indicated by a LV
mass index (LVMI)
>
51 g/m
2.7
and LV geometry was defined
as normal, or with concentric remodelling, eccentric or
concentric hypertrophy, using relative wall thickness (RWT)
and LVMI.
Results:
Compared to patients with normal kidney function,
CKD patients had higher uric acid levels (450
±
166 vs 306
±
107
µ
mol/l;
p
≤
0.001), a greater proportion of LVH (37
vs 14%;
p
≤
0.05) and longstanding diabetes (13
±
8 vs 8
±
6 years;
p
≤
0.001). Their left ventricular internal diameter,
diastolic (LVIDD) was (47.00
±
6.00 vs 43.00
±
7.00 mm;
p
≤
0.001), LVMI was (47
±
19 vs 36.00
±
15 g/m
2.7
;
p
≤
0.05) and
proportions of concentric (22 vs 11%;
p
≤
0.05) or eccentric
(15 vs 3%;
p
≤
0.05) LVH were also greater. Severe CKD was
associated with increased interventricular septum, diastolic
(IVSD) (12.30
±
3.08 vs 9.45
±
1.94 mm;
p
≤
0.05), posterior
wall thickness, diastolic (PWTD) (11.61
±
2.78 vs 9.52
±
1.77
mm;
p
≤
0.01), relative wall thickness (RWT) (0.52
±
0.17
vs 0.40
±
0.07;
p
≤
0.01) rate of LVH (50 vs 30%;
p
≤
0.05),
and elevated proportions of concentric remodelling (25 vs
15%;
p
≤
0.05) and concentric LVH (42 vs 10%;
p
≤
0.05)
in comparison with patients with moderate CKD. In multi-
variable adjusted analysis, hyperuricaemia emerged as the
only predictor of the presence of LVH in patients with CKD
(adjusted OR 9.10; 95% CI: 2.40–33.73).
Conclusion:
In keeping with a higher rate of cardiovascu-
lar events usually reported in patients with impaired renal
function, CKD patients exhibited LVH and abnormal LV
geometry.
Keywords:
type 2 diabetes, chronic kidney disease, left ventricu-
lar hypertrophy, prevalence, predictors
Submitted 1/2/10, accepted 3/6/11
Cardiovasc J Afr
2012;
23
: 73–77
DOI: 10.5830/CVJA-2011-028
Prevention of cardiovascular disease (CVD) requires early detec-
tion and correction of predisposing conditions and risk factors in
susceptible subjects.
1
Diabetes is a major risk factor for CVD, the
prognosis of which lies not only in the level of plasma glucose
but also in associated factors such as left ventricular hypertrophy
(LVH).
2
The latter develops frequently among diabetic patients,
including blacks, and has been identified as a powerful marker of
impaired prognosis.
2
Besides hyperglycaemia, various conditions
such as aging, hypertension, obesity, central obesity, dyslipidae-
mia and physical inactivity are known to alter LV structure.
2
Several reports have indicated that chronic kidney disease
(CKD) is independently associated with the presence of LVH on
echocardiography, suggesting that CKD might be related to LV
mass index (LVMI).
3-5
Individuals with LVH have eccentric or
concentric hypertrophy as a result of both pressure and volume
overload.
4
Moderate to severe CKD affects 15 to 33% of diabetic
patients and predicts the occurrence of CVD.
6,7
Therefore,
diabetic patients with CKD might be at a high risk for LVH
and subsequent CVD in comparison with those without renal
dysfunction.
6,7
Such an association holds more risk for black people, whose
high propensity to diabetic nephropathy has often been docu-
mented.
1
There is a need to document the impact of renal func-
tion on CV morbidity and mortality in diabetic patients with
CKD, particularly blacks.
1
The aim of the present study was to
evaluate the association between CKD and LV structural altera-
tions in a clinic-based sample of consecutive Congolese patients
with type 2 diabetes mellitus.
Methods
We enrolled in the present study consecutive type 2 diabetes
subjects aged 20 years and older attending the outpatient clinic
Department of Internal Medicine, Division of Endocrinology,
University of Kinshasa Hospital, Democratic Republic of the
Congo (DRC)
MP BAYAULI, MD
Department of Internal Medicine, Division of Nephrology,
University of Kinshasa Hospital, Democratic Republic of the
Congo (DRC)
FB LEPIRA, MD,
Department of Epidemiology and Biostatistics, Kinshasa
School of Public Health, University of Kinshasa, Democratic
Republic of the Congo (DRC)
PK KAYEMBE, MD, MPh, PhD
Hypertension Unit, University of Kinshasa Hospital,
Democratic Republic of the Congo (DRC)
JR M’BUYAMBA-KABANGU, MD
