Silent Myocardial Ischemia in CKD Stage 3-5: Prevalence and Predictors

BACKGROUND: Silent myocardial ischemia (SMI) is a major but often underdiagnosed cardiovascular complication in patients with chronic kidney disease (CKD), particularly in advanced stages. OBJECTIVE: This study aims to determine the prevalence of silent myocardial ischemia and identify its clinical and biochemical predictors among patients with CKD stage 3-5. METHODS: This was a cross-sectional analytical study conducted at Allama Iqbal Medical College, Lahore, Pakistan, from January 2024 to December 2024. Data were collected using a structured questionnaire specifically designed for this study. Demographic information such as age, gender, and body mass index (BMI) was recorded for each participant. RESULTS: The prevalence of silent myocardial ischemia was found to be 37.4% (n = 89) in the study population. Patients with SMI were significantly older (mean age: 61.2 ± 10.5 years) compared to those without SMI (mean age: 57.1 ± 11.3 years) (p = 0.01). Diabetes mellitus was present in 82% of patients with SMI compared to 57.3% of those without (p < 0.001). Left ventricular hypertrophy (LVH) was observed in 55% of patients with SMI versus 31.4% of patients without SMI (p = 0.002). Elevated parathyroid hormone levels (>150 pg/mL) were seen in 73% of patients with SMI compared to 61% of patients without SMI (p = 0.047). Logistic regression analysis identified age > 60 years (adjusted odds ratio (AOR): 2.1; 95% confidence interval (CI): 1.2-3.5), diabetes mellitus (AOR: 2.9; 95% CI: 1.6-5.3), left ventricular hypertrophy (AOR: 2.4; 95% CI: 1.3-4.3), and elevated parathyroid hormone (PTH) levels (AOR: 1.8; 95% CI: 1.0-3.2) as independent predictors of SMI. CONCLUSION: Silent myocardial ischemia is common in patients with CKD stage 3-5 and is independently associated with age, diabetes mellitus, left ventricular hypertrophy, and elevated PTH levels. Routine screening for SMI in high-risk patients with CKD is warranted to enable early detection and prevention of major cardiovascular events. Future longitudinal studies are recommended to assess the long-term impact of such screening and intervention strategies.