Cardiovascular risk factors in patients with end stage renal failure on regular hemodialysis

ABSTRACT

To investigate the relation between both fibrinogen, C-reactive protein [CRP], hemocysteine [Hcy], lipoprotein a [Lpa], as a non traditional cardiovascular [CV] risk factors, plasma lipids, hypertension, smoking and the occurrence and severity of ischemic heart disease [IHD] in patients with end stage renal failure [ESRF] on regular hemodialysis [HD] and weather diabetic patients are a high risk than non diabetic. 50 ESRF patients on regular HD divided into 3 groups Group I included 10 patients free from IHD as control. Group II included 20 non-diabetic patients. Group IIIincluded 20 type 2 diabetic patients. Both group II, III suffer from IHD. All patients were subjected to full history, clinical examination, routine investigations, evaluation of fibrinogen, quantitative CRP, serum Hcy Lpa, HDL, LDL cholesterol, triglycerides.12-leads surface ECG, resting and dobutamine stress echocardiography [DSE] were also done. Plasma fibrinogen was significantly higher in group III compared to both group I, II [F=20.2, P < 0.001]. There was significant increase in serum CRP in group II compared to I, III and in group III compared to group I [F=19.57, 0.001]. Plasma total Hcy was significantly higher in group II, and III compared to group I [F = 9 .27, P < 0.001], [pa was significantly increased in group II, III compared k group I while there was non significant difference between group II and III [F=6 .9 P > 0.05]. Interventricular septal thickness was significantly higher in group II .III compared to group I [F=5.2, P < 0.009]. Left ventricular posterior wall thickness was significantly increased in group II compared to group I [P < 0.001]. Dobutamine stress echo wall motion score [WMS] and wall motion score index [WMSI] were significantly higher in group II, and III compared to group I [F = 28.8, P < 0.001] and [F=27.4, P < 0.001] respectively. Factorial analysis and multiple regression analysis for cardiovascular risk factors revealed that high fasting blood glucose, fibrinogen, [pa. and dyslipideamia were independent risk factors in ESRF patients on regular HD [t 3.52 p < 0.001, t 3.26 p < 0.002, t 2.76 p < 0.008, t 2.19 p < 0.034, respective1y]. In conclusion, there are a considerable traditional and non traditional CV risk factors may affect ESRF patients on regular HD. Of them diabetes mellitus is the highest followed by elevated plasma fibrinogen, plasma Lpa, and dyslipidemia