CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 2, March 2012
AFRICA
75
among CKD patients was increased by hyperuricaemia (aOR
9.10; 95% CI: 2.40–33.74) for the presence versus the absence
of hyperuricaemia.
Discussion
The key finding of the study was that the elevated prevalence of
chronic kidney disease in our diabetic patients was associated
with abnormal cardiac structure. The alteration in renal function
was moderate in the majority of cases. Left ventricular mass
index, the frequency of left ventricular hypertrophy and uric
acid levels were higher in CKD patients in whom multivariable
adjusted analysis indicated uric acid as the only predictor of LVH.
The elevated prevalence of moderate to severe CKD has been
reported in 15 to 23% of diabetic patients in whom it predicts
the occurrence of CVD.
18,19
The mechanisms by which chronic
hyperglycaemia may induce cardiovascular and renal dysfunc-
tion include enhanced polyol pathway flux, altered redox state,
increased formation of diacylglycerol (DAG) and subsequent
activation of protein kinase C (PKC) isoforms, and accelerated
TABLE 1. CLINICAL CHARACTERISTICS OF THEWHOLE
GROUPAND DIABETICSWITHANDWITHOUT CKD
Characteristic
Whole group
(
n
=
60)
Normal renal
function
(
n
=
28)
CKD
(
n
=
32)
Gender: M/F
23/37
11/17
12/20
Age (years)
58
±
8
59
±
8
58
±
8
Duration DM (years)
11
±
8
8
±
6
13
±
8***
Central obesity (%)
62
32
30
AHT (%)
80
37
43
MS (%)
58
28
30
Antidiabetic drugs (%)
97
45
52
Antihypertensive drugs (%)
67
25
42**
Smoking (%)
10
7
3
BMI (kg/m
2
)
26
±
5
27
±
6
26
±
5
Waist (cm)
95
±
12
96
±
13
95
±
12
SBP (mmHg)
148
±
26
148
±
29
149
±
23
DBP (mmHg)
84
±
13
86
±
15
82
±
11
PP (mmHg)
64
±
21
61
±
23
67
±
19
Heart rate (beats/min)
83
±
15
83
±
20
86
±
12
Data are expressed as mean ± SD or relative frequency in per cent.
CKD, chronic kidney disease; M, male; F, female; DM, diabetes mellitus;
AHT, arterial hypertension; MS, metabolic syndrome; BMI, body mass
index; SBP, systolic blood pressure; DBP, diastolic blood pressure; PP,
pulse pressure.
*
p
≤
0.05; **
p
≤
0.01; ***
p
≤
0.001in comparison with normal renal
function.
TABLE 2. BIOLOGICAL CHARACTERISTICS OF THE
PATIENTSAND DATAACCORDINGTO RENAL FUNCTION
Characteristic
Whole group
(
n
=
60)
Normal renal
function
(
n
=
28)
CKD
(
n
=
32)
TC (mmol/l)
5.61
±
1.62 5.74
±
1.40 5.62
±
1.71
LDL-C (mmol/l)
3.80
±
1.54 3.90
±
1.42
3.73
±
0.78
HDL-C (mmol/l)
1.45
±
0.67 1.44
±
0.51 1.53
±
0.84
TG (mmol/l)
1.60
±
1.30 1.84
±
1.80 1.33
±
0.78
Glucose (mmol/l)
8.10
±
3.31 8.27
±
2.77 7.80
±
3.80
Uric acid (µmol/l)
410
±
178
309
±
107 500
±
166***
CrCl (ml/min/173 m
2
)
64
±
41
97
±
35
35
±
18
24-h proteinuria (g)
0.79
±
1.72 0.07
±
0.164 1,42
±
2,17
Data are expressed as mean ± SD
CKD, chronic kidney disease; TC, total cholesterol; LDL-C, low-density
lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TG,
triglycerides; CrCl, creatinine clearance.
*
p
≤
0.05; **
p
≤
0.01; ***
p
≤
0.001 in comparison with normal renal
function.
TABLE 3. M-MODE ECHOCARDIOGRAPHIC DATA IN THE
WHOLE GROUPAND DIABETICSWITHANDWITHOUT CKD
Characteristic
Whole group
(
n
=
60)
Normal renal
function
(
n
=
28)
CKD
(
n
=
32)
LV dimension
LVIDD (mm)
44.83
±
6.62 43.00
±
7.00 47.0
±
6.00***
LVIDS (mm)
29.67
±
8.43 28.04
±
7.72 31.09
±
8.98
IVSD (mm)
10.42
±
2.60 10.30
±
2.41 11.00
±
3.48
PWTD (mm)
9.98
±
2.26 10.00
±
2.00 10.00
±
2.30
RWT
0.46
±
0.13 0.47
±
0.12 0.45
±
0.13
LVMI (g/m
2.7
)
41.83
±
17.72 36.00
±
15.00 47.00
±
19.00*
EF (%)
68.25
±
19.06 69.24
±
17.02 67.39
±
20.91
FS (%)
LV geometry
0.34
±
0.13 0.34
±
0.13
0.34
±
0.14
Normal (%)
43
43
44
Concentric remodelling (%)
30
43
19*
Concentric hypertrophy (%)
17
11
22*
Eccentric hypertrophy (%)
10
3
15*
Data are expressed as mean
±
SD or relative frequency in per cent.
CKD, chronic kidney disease; LVIDD, left ventricular internal diameter,
diastolic; LVIDS, left ventricular internal diameter, systolic; IVSD, interven-
tricular septum, diastolic; PWTD, posterior wall thickness, diastolic; RWT,
relative wall thickness; LVMI, left ventricular mass index; EF, ejection frac-
tion; FS, fraction shortening.
*
p
≤
0.05; **
p
≤
0.01; ***
p
≤
0.001 in comparison with normal renal func-
tion.
TABLE 4. SEVERITY OF RENAL DYSFUNCTIONAND M-MODE
ECHOCARDIOGRAPHIC DATAAMONG DIABETICSWITH CKD
CrCl
30–60 ml/ min
(
n
=
20)
CrCl
<
30 ml/ min
(
n
=
12)
LV dimension
LVIDD (mm)
46.75
±
5.72 46.75
±
6.79
LVIDS (mm)
30.50
±
9.76 32.08
±
7.80
IVSD (mm)
9.45
±
1.94 12.30
±
3.08*
PWTD (mm)
9.52
±
1.77 11.61
±
2.78**
RWT
0.40
±
0.07 0.52
±
0.17**
LVMI (g/m
2.7
)
43.52
±
15.74 52.41
±
22.40
FS (%)
0.35
±
0.15 0.32
±
0.11
LV geometry
Normal, %
55
25*
Concentric remodelling (%)
15
25*
Concentric hypertrophy (%)
10
42*
Eccentric hypertrophy (%)
20
8*
Data are expressed as mean
±
SD or relative frequency in per cent.
CKD, chronic kidney disease; CrCl, creatinine clearance; LVIDD, left
ventricular internal diameter, diastolic; LVIDS, left ventricular internal
diameter, systolic; IVSD, interventricular septum, diastolic; PWTD,
posterior wall thickness, diastolic; RWT, relative wall thickness; LVMI,
left ventricular mass index; EF, ejection fraction; FS, fraction shortening.
*
p
≤
0.05; **
p
≤
0.01; ***
p
≤
0.001 in comparison with moderate CKD.
