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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
56
VOLUME 13 NUMBER 2 • DECEMBER 2016
Left ventricular hypertrophy and geometry in type 2
diabetes patients with chronic kidney disease:
an echocardiographic study
MP BAYAULI, FB LEPIRA, PK KAYEMBE, JR M’BUYAMBA-KABANGU
Correspondence to: FB Lepira
Department of Internal Medicine, Division of Nephrology, University of
Kinshasa Hospital, Democratic Republic of the Congo
e-mail:
lepslepira@yahoo.frMP Bayauli
Department of Internal Medicine, Division of Endocrinology, University of
Kinshasa Hospital, Democratic Republic of the Congo
PK Kayembe
Department of Epidemiology and Biostatistics, Kinshasa, School of Public
Health, University of Kinshasa, Democratic Republic of the Congo
JR M’Buyamba-Kabangu
Hypertension Unit, University of Kinshasa Hospital, Democratic Republic of
the Congo
Previously published in
Cardiovasc J Afr
2012;
23
: 73–77
S Afr J Diabetes Vasc Dis
2016;
13
: 56–60
Abstract
Objective:
We assessed left ventricular structural alterations
associated with chronic kidney disease (CKD) in Congolese
patients with type 2 diabetes.
Methods:
This was a cross-sectional study of a case series.
We obtained anthropometric, clinical, biological and
echocardiographic measurements in 60 consecutive type 2
diabetes patients (37 females, 62%) aged 20 years or older
from the diabetes outpatient clinic, University of Kinshasa
Hospital, DRC. We computed creatinine clearance rate
according to the MDRD equation and categorised patients
into mild (CrCl > 60 ml/min per 1.73 m
2
), moderate (CrCl 30–60
ml/ min per 1.73 m
2
) and severe CKD (< 30 ml/min per 1.73
m
2
). Left ventricular hypertrophy (LVH) was indicated by a LV
mass index (LVMI) > 51 g/m
2.7
and LV geometry was defined as
normal, or with concentric remodelling, eccentric or concentric
hypertrophy, using relative wall thickness (RWT) and LVMI.
Results:
Compared to patients with normal kidney function,
CKD patients had higher uric acid levels (450 ± 166 vs 306
± 107 μmol/l;
p
≤ 0.001), a greater proportion of LVH (37 vs
14%;
p
≤ 0.05) and longstanding diabetes (13 ± 8 vs 8 ± 6
years;
p
≤ 0.001). Their left ventricular internal diameter,
diastolic (LVIDD) was (47.00 ± 6.00 vs 43.00 ± 7.00 mm;
p
≤
0.001), LVMI was (47 ± 19 vs 36.00 ± 15 g/m
2.7
;
p
≤ 0.05) and
proportions of concentric (22 vs 11%;
p
≤ 0.05) or eccentric
(15 vs 3%;
p
≤ 0.05) LVH were also greater. Severe CKD was
associated with increased interventricular septum, diastolic
(IVSD) (12.30 ± 3.08 vs 9.45 ± 1.94 mm;
p
≤ 0.05), posterior
wall thickness, diastolic (PWTD) (11.61 ± 2.78 vs 9.52 ± 1.77
mm;
p
≤ 0.01), relative wall thickness (RWT) (0.52 ± 0.17 vs
0.40 ± 0.07;
p
≤ 0.01) rate of LVH (50 vs 30%;
p
≤ 0.05), and
elevated proportions of concentric remodelling (25 vs 15%;
p
≤ 0.05) and concentric LVH (42 vs 10%;
p
≤ 0.05) in comparison
with patients with moderate CKD. In multivariable adjusted
analysis, hyperuricaemia emerged as the only predictor of
the presence of LVH in patients with CKD (adjusted OR 9.10;
95% CI: 2.40–33.73).
Conclusion:
In keeping with a higher rate of cardiovascular
events usually reported in patients with impaired renal
function, CKD patients exhibited LVH and abnormal LV
geometry.
Keywords:
type 2 diabetes, chronic kidney disease, left ventricular
hypertrophy, prevalence, predictors
Prevention of cardiovascular disease (CVD) requires early detection
and correction of predisposing conditions and risk factors in
susceptible subjects.
1
Diabetes is a major risk factor for CVD, the
prognosis of which lies not only in the level of plasma glucose but
also in associated factors such as left ventricular hypertrophy (LVH).
2
The latter develops frequently among diabetic patients, including
blacks, and has been identified as a powerful marker of impaired
prognosis.
2
Besides hyperglycaemia, various conditions such as
aging, hypertension, obesity, central obesity, dyslipidaemia and
physical inactivity are known to alter LV structure.
2
Several reports have indicated that chronic kidney disease
(CKD) is independently associated with the presence of LVH on
echocardiography, suggesting that CKD might be related to LV mass
index (LVMI).
3-5
Individuals with LVH have eccentric or concentric
hypertrophy as a result of both pressure and volume overload.
4
Moderate to severe CKD affects 15 to 33% of diabetic patients
and predicts the occurrence of CVD.
6,7
Therefore, diabetic patients
with CKD might be at a high risk for LVH and subsequent CVD in
comparison with those without renal dysfunction.
6,7
Such an association holds more risk for black people, whose high
propensity to diabetic nephropathy has often been documented.
1
There is a need to document the impact of renal function on CV
morbidity and mortality in diabetic patients with CKD, particularly
blacks.
1
The aim of the present study was to evaluate the association
between CKD and LV structural alterations in a clinic-based sample
of consecutive Congolese patients with type 2 diabetes mellitus.
Methods
We enrolled in the present study consecutive type 2 diabetes
subjects aged 20 years and older attending the outpatient clinic at
the University of Kinshasa Hospital. Ethical approval was obtained
from the institutional ethics review board and informed consent
was obtained from the study participants. Exclusion criteria
included ischaemic heart disease (IHD), acute coronary syndrome