ABSTRACT
Background:
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Understanding CVD prevalence and risk factors in these populations is essential for improving outcomes. This study assesses CVD prevalence and associated risk factors among CKD and ESRD patients in India.
Materials and Methods:
A cross-sectional study was conducted from January 2022 to December 2023 at Acharya Vinoba Bhave Rural Hospital, India, including 800 adult CKD stage 3 to 5 patients, with and without dialysis. Data collection involved patient interviews, medical record reviews, clinical exams, and biochemical assessments. Logistic regression analysis identified independent predictors of CVD.
Results:
Among participants, 35% had coronary artery disease, 27.5% had heart failure, 20% had arrhythmias, and 15% had cerebrovascular disease. CVD prevalence was higher in ESRD patients compared to CKD patients. Significant predictors included age, hypertension, diabetes, dyslipidemia, and ESRD status, with ESRD patients showing more than double the odds of developing CVD (OR 2.50, 95% CI 1.85–3.40, P < 0.001).
Conclusion:
This study reveals a high burden of CVD among CKD and ESRD patients in India, particularly in those with ESRD. Early identification and management of cardiovascular risk factors in CKD patients are crucial to reducing the risk of complications.
KEYWORDS: Cardiovascular disease (CVD), chronic kidney disease (CKD), end-stage renal disease (ESRD), India, prevalence, risk factors
BACKGROUND
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major global health issues linked to high morbidity and mortality, primarily due to cardiovascular disease (CVD) complications. The global CKD prevalence is estimated at 8–16%,[1] with India’s prevalence reaching up to 17.2%, posing significant healthcare challenges.[2] As CKD advances, CVD risk rises, making it the leading cause of death in ESRD patients.[3]
The CKD–CVD relationship is multifactorial, involving both traditional risk factors like hypertension and diabetes and nontraditional factors such as oxidative stress, inflammation, and mineral metabolism issues.[4,5] CVD mortality in ESRD patients is 10 to 30 times higher than in the general population.[6] Limited data exist on CVD prevalence and risk factors among CKD and ESRD patients in India, where high rates of diabetes and hypertension contribute significantly to these conditions.[7] Resource constraints and limited healthcare access further hinder CKD management in India.[8] This study aims to assess CVD prevalence and identify risk factors among CKD and ESRD patients in India, guiding interventions to reduce cardiovascular morbidity and mortality in this population.
MATERIALS AND METHODS
Study setting and design
This cross-sectional study was conducted at Acharya Vinoba Bhave Rural Hospital, India, from January 2022 to December 2023, aiming to assess cardiovascular disease (CVD) prevalence among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. Data were collected in both outpatient and inpatient settings to ensure a diverse patient sample.
Study population
The study included 800 adult CKD stage 3 to 5 patients, including those on dialysis, recruited from nephrology clinics and wards. Patients with a history of renal transplantation or acute kidney injury were excluded to focus on chronic conditions.
Data collection
Data collection involved structured interviews, medical record reviews, and clinical exams. Interviews gathered demographic and lifestyle information, while clinical exams and ECGs assessed cardiovascular health.[9,10,11,12] Blood samples were analyzed for biochemical markers, including lipid profiles and specific cardiovascular biomarkers, using advanced laboratory equipment.[13,14]
Statistical analysis
SPSS version 26.0 was used for analysis. Descriptive statistics summarized demographic and clinical data, while logistic regression identified independent CVD predictors. A P value <0.05 was considered statistically significant.
Ethical considerations
The study adhered to the Declaration of Helsinki guidelines, with ethical approval from the Institutional Ethics Committees. Informed consent was obtained, and all data were anonymized to protect patient confidentiality.
RESULT
Table 1: Demographic and clinical characteristics of the study population The demographic and clinical characteristics indicate that the study population has a significant burden of cardiovascular risk factors, particularly in the ESRD group. Patients with ESRD tend to be older and have a higher prevalence of diabetes and dyslipidemia compared to those with CKD, suggesting that these risk factors might be more pronounced as renal disease progresses.
Table 1.
Demographic and clinical characteristics of the study population
| Characteristic | Total (n=800) | CKD (n=500) | ESRD (n=300) |
|---|---|---|---|
| Age (years), mean±SD | 60.5±12.3 | 58.7±11.9 | 63.4±13.2 |
| Gender (male), n (%) | 480 (60%) | 290 (58%) | 190 (63.3%) |
| Hypertension, n (%) | 680 (85%) | 410 (82%) | 270 (90%) |
| Diabetes mellitus, n (%) | 450 (56.3%) | 250 (50%) | 200 (66.7%) |
| Smoking, n (%) | 240 (30%) | 160 (32%) | 80 (26.7%) |
| Dyslipidemia, n (%) | 550 (68.8%) | 320 (64%) | 230 (76.7%) |
Table 2: Prevalence of cardiovascular disease in CKD and ESRD patients The prevalence of cardiovascular disease is notably higher in the ESRD population, with coronary artery disease and heart failure being the most prevalent conditions. This underscores the increased cardiovascular risk associated with advanced renal disease, highlighting the need for targeted interventions in this group.
Table 2.
Prevalence of cardiovascular disease in CKD and ESRD patients
| Cardiovascular condition | Total (n=800) | CKD (n=500) | ESRD (n=300) |
|---|---|---|---|
| Coronary artery disease (CAD), n (%) | 280 (35%) | 150 (30%) | 130 (43.3%) |
| Heart failure, n (%) | 220 (27.5%) | 120 (24%) | 100 (33.3%) |
| Arrhythmias, n (%) | 160 (20%) | 90 (18%) | 70 (23.3%) |
| Cerebrovascular disease, n (%) | 120 (15%) | 70 (14%) | 50 (16.7%) |
Table 3: Logistic regression analysis of factors associated with cardiovascular disease The logistic regression analysis reveals that age, hypertension, diabetes mellitus, dyslipidemia, and ESRD are significant predictors of cardiovascular disease. Notably, ESRD patients have more than double the odds of developing cardiovascular disease compared to those with CKD, emphasizing the critical need for aggressive cardiovascular risk management in these patients.
Table 3.
Logistic regression analysis of factors associated with cardiovascular disease
| Variable | Odds ratio (OR) | 95% Confidence interval (CI) | P |
|---|---|---|---|
| Age (per year increase) | 1.05 | 1.02–1.08 | <0.001 |
| Male gender | 1.20 | 0.95–1.52 | 0.12 |
| Hypertension | 2.30 | 1.70–3.10 | <0.001 |
| Diabetes mellitus | 1.80 | 1.35–2.40 | <0.001 |
| Dyslipidemia | 1.40 | 1.05–1.90 | 0.02 |
| ESRD vs. CKD | 2.50 | 1.85–3.40 | <0.001 |
DISCUSSION
This study reveals a significant burden of cardiovascular disease (CVD) among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients in India, with higher CVD prevalence in the ESRD group, consistent with increased cardiovascular risk in advanced kidney disease.[3,15] The observed rates of coronary artery disease (35%) and heart failure (27.5%) align with global data, highlighting CVD as a leading cause of morbidity and mortality in these patients.[16] Traditional and nontraditional risk factors, such as hypertension (85%), diabetes (56.3%), and dyslipidemia (68.8%), were prevalent, underscoring their role in CVD progression.[5,17,18]
Age significantly influenced CVD risk, with each additional year increasing CVD odds by 5%, reflecting the cumulative impact of aging.[19] ESRD emerged as a strong predictor, with patients having more than double the odds of developing CVD, highlighting the cardiovascular risks linked to the uremic environment and hemodynamic changes in ESRD.[20] Dialysis in ESRD added further complications, including volume overload and electrolyte imbalances.[21]
The findings emphasize the need for early identification and management of CVD risk factors in CKD, especially as patients progress to ESRD. Interventions, like blood pressure control and lipid-lowering therapies, are crucial but challenging to implement in resource-limited settings like India.[21,22,23,24]
Limitations
The cross-sectional design limits causal inferences between CKD, ESRD, and CVD. The study’s focus on a tertiary care center may affect the generalizability to broader populations, particularly in rural areas. Reliance on self-reported data introduces potential recall bias, and the lack of longitudinal data limits insights into disease progression.
CONCLUSION
This study highlights the significant burden of cardiovascular disease (CVD) among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients in India. As kidney disease progresses, CVD prevalence rises sharply, with ESRD patients being most at risk. Key contributors to this increased risk include age, hypertension, diabetes, and dyslipidemia. The findings emphasize the need for early detection and proactive management of cardiovascular risk factors in CKD patients, especially as they near ESRD. A multidisciplinary approach, integrating nephrology and cardiology, is essential to improving outcomes for these patients.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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