Cardiovascular Disease in Advanced Chronic Kidney Disease in a Tertiary Institution, Johannesburg, South Africa

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with advanced chronic kidney disease (CKD). However, data on its prevalence and patterns in Sub-Saharan Africa remain scarce. Purpose: To determine the prevalence and spectrum of CVD among patients with advanced CKD in Johannesburg, South Africa. Patients and Methods: This retrospective study enrolled adults aged ≥ 18 years with advanced CKD attending the renal clinic at Chris Hani Baragwanath Academic Hospital between 2009 and 2018. Demographic, clinical, laboratory, electrocardiographic, and echocardiographic variables were extracted from medical records. CVD was defined as heart failure, ischemic heart disease, arrhythmias, non-rheumatic valvular heart disease, pericardial disease, stroke, or peripheral vascular disease, supplemented by clinical, electrocardiographic, or echocardiographic findings. Patients were grouped by their CVD status. Multivariable logistic regression identified independent factors associated with CVD. Results: Among 300 participants (mean age of 55.3 ± 15.0 years, 54.3% males), CVD prevalence was 58.7%. The mean age at CVD diagnosis was 46.6 ± 13.7 years, with a median interval of 8.3 months (IQR, 2.5– 27.6) between the onset of CKD and CVD diagnosis. Patients with CVD were younger than those without (52.8 ± 13.8 vs 58.8 ± 16.0 years; p < 0.001), had higher diastolic blood pressure (88.5 ± 20.6 vs 81.3 ± 17.6 mmHg; p = 0.002), and a higher prevalence of obesity (54.6% vs 38.7%; p < 0.001). Predominant CVD manifestations were ischemic ECG changes (95.1%) and diastolic dysfunction with heart failure (45.5%). Higher diastolic blood pressure (aOR 1.04; 95% CI 1.00– 1.08; p = 0.029) and reduced estimated GFR (aOR 0.96; 95% CI 0.94– 0.99; p = 0.022) were independent predictors of CVD. Conclusion: CVD is highly prevalent in advanced CKD and occurs at a young age. Early cardiovascular risk assessment and integrated cardio-renal management strategies are essential in this high-risk population.