LEFT VENTRICULAR HYPERTROPHY IN AFRICAN BLACK PATIENTS WITH CHRONIC RENAL FAILURE AT FIRST EVALUATION Objective: Chronic kidney disease (CKD) is a major cause of cardiovascular morbidity and mortality all over the world. The combined effect of volume and pressure overload seen in patients with CKD is the primary cause of left ventricular hypertrophy (LVH). Though it accounts for a significant proportion of patients dying in hospitals in Nigeria, information on CKD in African Blacks is lacking. This study evaluates the prevalence of LVH and factors affecting it in pre- dialysis patients by using echocardiography. Design, Setting and Patients: One hundred consecutive patients with CKD who were attending the medical outpatient and renal clinics of University of Nigeria Teaching Hospi- tal, Enugu, who satisfied the inclusion criteria were screened for the study. Eighty-eight patients completed the study. Forty-five age- and sex-matched subjects were selected as controls. Clinical and laboratory parameters and echocardiographic indices were measured. Results: Left ventricular hypertrophy (LVH), defined in absolute terms as left ventricular mass index .134 g/m 2 in men and .110 g/m 2 in women was present in 95.5% of patients and 6.7% of controls. The most prevalent type of LVH was eccentric hypertrophy, which was found in 54.6%, while concentric was seen in 40.9%. Hypertension was present in 85.2% of the patients. The predominant causes of CKD were chronic glomerulonephritis (43.2%), hyperten- sion (25%), and diabetes mellitus (14.8%). All the patients studied had advanced CKD, either stage 4 or 5 of the Kidney Disease Outcome Quality Initiative classification of CKD. Stepwise method of multiple linear regressions identified mean arterial pressure (32%), hemoglobin concentra- tion (22%), male sex (17%), and creatinine clearance (24%) as predictors of LVH in CKD. Conclusion: This study showed a strong associ- ation between CKD and LVH in patients in developing countries at the time of first evalua- tion by a nephrologist. It demonstrated a high prevalence of LVH in patients at first evaluation. The patients were often anemic and had severe hypertension even at first presentation. Early detection and treatment of causes of CKD should be pursued aggressively at the primary pre- vention level, as has been advocated by the International Society of Nephrology to reduce the effects of CKD and its attendant complications in the society. (Ethn Dis. 2006;16:859–864) Key Words: Anemia, Cardiovascular Risk, CKD, Hypertension, Left Ventricular Hyper- trophy, Mean Arterial Pressure Ifeoma I. Ulasi, FWACP; Ejikeme B. Arodiwe, FWACP; Chinwuba K. Ijoma, FMCP INTRODUCTION Chronic kidney disease (CKD) is a major cause of cardiovascular morbid- ity and mortality all over the world. 1 In Nigeria and most parts of Africa, chronic renal failure accounts for a sig- nificant proportion of deaths in hospi- tals. 2 Even in advanced countries, CKD remains a major health problem, 3,4 causing cardiovascular diseases such as congestive cardiac failure, myocardial infarction, hypertension, stroke, and sudden cardiac death in patients with chronic renal failure (CRF). The hemo- dynamic and metabolic changes associ- ated with CRF affect the cardiovascular system (especially the heart) adversely; more often than not, various cardiac layers and coronary vessels are affected. 5 Many patients on dialysis die of un- known cardiac causes that are thought to be related to high prevalence of left ventricular hypertrophy (LVH). 6 Co- founding factors of LVH seen in these patients include hemodynamic factors such as hypertension, fluid overload, and anemia and non-hemodynamic factors such as metabolic and endocrine abnormalities, autonomic dysfunction, ischemic heart disease, and cardiomy- opathy. 5 Other putative risk factors may include iron and aluminum overload, hyperparathyroidism, and some un- known uremic toxins. These factors cause volume and/or pressure overload, and the combined effect of these overloads is thought to be the primary cause of LVH. 7,8 Cardiac hypertrophy occurs in patterns specific to inciting mechanical stress; therefore, volume overload results in eccentric hypertrophy while pressure overload would give concentric hypertrophy. 9 In end-stage renal disease (ESRD) patients, LVH is closely related to systolic or pulse pressure. 9 London described systolic blood pressure (SBP) and pulse pressure as simplified markers of pressure load that result from in- teraction between cardiac factors, ie, stroke volume, ejection velocity, and the opposition to left ventricular ejection. 8 The prevalence of LVH increases as kidney function worsens and may be as high as 70%–80% before initiation of dialysis. 5,8,10 Left ventricular hypertrophy (LVH) is documented as the most frequent cardiac alteration in ESRD and is an independent risk factor for survival in these patients. 6,8 Though LVH has been reported in essential hypertension and CKD, a close association of LVH with blood pressure level has not been uniform- ly documented in patients with CKD. 11 Chronic renal failure (CRF) patients make up to 2%–8% of all hospital admissions in Nigeria, 2 and though car- diovascular complications are prevalent in them, information on LVH in African Black CKD patients is lacking. This study evaluates the prevalence of LVH and factors affecting it in pre-dialysis CRF patients by using echocardiography. METHOD The study was done at the Univer- sity of Nigeria Teaching Hospital, From the Renal Unit, Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Ni- geria. Address correspondence and reprint requests to Ifeoma I. Ulasi; Renal Unit; Department of Medicine; College of Medi- cine; UNTH; Enugu, Nigeria; ifeomaulasi @yahoo.co.uk Ethnicity & Disease, Volume 16, Autumn 2006 859