Cardiovascular complications in adult patients with chronic kidney disease attending a tertiary hospital in Dodoma, Tanzania; a prospective longitudinal study

Chronic kidney disease (CKD) represents a primary contributor to mortality, with the majority of fatal outcomes driven by cardiovascular events. The aim of this study was to determine the prevalence, patterns, factors associated with and outcomes of cardiovascular complications in patients with CKD in Dodoma, Tanzania. Between October 2022 and June 2023, a prospective longitudinal study evaluated adult patients with CKD stages 3 and 4 attending at the Benjamin Mkapa Hospital nephrology clinic in Dodoma. A baseline questionnaire captured patient demographics, clinical details, and laboratory metrics. Cardiovascular complications were determined by Electrocardiography (ECG) and echocardiography (ECHO) at baseline and after 6 months of follow-up. Data was entered into an Excel spread sheet; descriptive and inferential statistics were done by SPSS program version 25. Binary logistic regression analysis was performed to identify factors associated with cardiovascular complications in adult patients with CKD. A total of 234 adult patients with CKD were enrolled into the study; 66.2% (155/234) of the patients were in CKD stage 3 and 61.1% (143/234) were female. The prevalence of cardiovascular complications was 76.1% (178/234), for patients with cardiovascular complications; the median body mass index (BMI) was 26.4 (25.0-28.1) Kg/m2, median eGFR was 33 (24–40) mL/min/1.73m2 and median low-density lipoprotein (LDL) was 3.73 (2.9–4.4) mmol/l. Also, 82.6% (147/178) of the patients were found with obesity, 74.7% (133/178) were found with elevated total cholesterol, 64.6% (115/178) of the patients were found with elevated LDL and 40.4% (72/178) of the patients were in CKD stage 4. Furthermore, 70.2% (125/178) of the patients were found with left ventricular hypertrophy and 50.0% (89/178) of the patients were found with heart failure. Factors associated with cardiovascular complications in adults with CKD included; obesity [AOR 2.47, 95% CI (1.75–8.07), P = 0.035], elevated total cholesterol [AOR 1.66, CI (1.27–2.62), P = 0.047], elevated LDL [AOR 1.87, CI (1.87–2.97), P = 0.039], age over 65 years [AOR 1.74, 95% CI (1.08–3.87), P = 0.039] and CKD stage 4 [AOR 4.21, CI (1.45–12.22), P = 0.008]. Majority, 83.7% (149/178) completed the six months follow-up; 32.9% (49/149) of the patients had worsening of their heart failure, 4.7% (7/149) of the patients were found with stroke and 1.3% (2/149) of the patients died. The prevalence of cardiovascular complications among adult patients with CKD is high in our settings. Obesity, elevated total cholesterol, elevated LDL, age above 65 years and CKD stage 4 served as prominent indicators for heightened cardiovascular risk.