MARCO TEORICO
4. LA MOTIVACION Y EL APRENDIZAJE AUTORREGULADO
CONCLUSION AND RECOMMENDATION FOR CLINICAL PRACTICE
CONCLUSION
The findings from this study, demonstrated that:
1. Prevalence of cardiovascular diseases such as LVH, CCF, sub-clinical atherosclerosis as determined by CIMT and stroke was higher in CKD patients than the controls. This highlights the importance of CVD as a cause of morbidity and mortality in CKD patients and reaffirms the statement by NKF that patients with CKD are in the highest risk group for cardiovascular disease.
2. Patients with CKD have high prevalence of traditional (hypertension, dyslipidemia) and non traditional (anaemia, CRP) risk factors for cardiovascular diseases. This is in keeping with reports in literature.
3. Some risk factors for CVD like hypertriglyceridaemia, anaemia and elevated CRP increased as GFR decreased among our patients population.
4. Some cardiovascular risk factors were associated with some CVDs. High SBP, DBP and MAP were associated with LVH. High DBP, MAP, LVMI and low haemoglobin were associated with CCF. High total cholesterol, LDL-cholesterol and triglycerides were CVD risk factors associated with Subclinical atherosclerosis while patients with Stroke had significantly higher total cholesterol, LDL-cholesterol and CIMT.
85 Recommendations for clinical Practice
1 Ultrasound assessment of carotid artery is a useful tool for early diagnosis of atherosclerosis. It is cheap, simple and highly reproducible and therefore recommended as a screening tool in high risk patients
2 Since CKD patients are considered to be in the highest risk group for cardiovascular disease. They should be carefully assessed and treated for cardiovascular risk factors early in the course of the disease.
3 Health education to create awareness among health personnel and patients on the importance of adequate control of these CVD risk factors would go a long way in ensuring early treatment by doctors and enhance compliance on the part of patients.
Recommendation for future studies
1. A longitudinal study is desirable to determine the actual relationship between these cardiovascular risk factors and the cardiovascular diseases and outcome in these patients
2. Studies to evaluate effects of various interventions to control the identified risk factors among the patients will also be desirable.
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97 APPENDIX I
QUESTIONNAIRE
This questionnaire is strictly for research purpose and all information supplied shall be handled confidentially .
PREVALENCE OF CVD AND CVD RISK FACTORS AMONG CKD PATIENTS SN --- Hosp No--- Sex--- Age---
Anthropometric indices; Wt. --- Ht. --- BMI---
Renal Status; Blood Cr--- CrCl (MDRD)---
CVD Risk Factors BP- 1st--- 2nd --- 3rd --- Average--- Hb--- T Cholesterol --- HDL --- LDL ---TG--- CRP---
CVD
Have you suffered from any of these conditions before?
1. Sudden numbness or weakness of face, arm or leg especially on one side of the body. Yes--- No---
If yes, when did it occur? Before---After--- diagnosis of your kidney disease 2. Sudden difficulty in seeing in one or both eyes. Yes --- No ----
If yes, when? Before--- After--- diagnosis of your kidney disease 3. Sudden confusion or difficulty in speaking or understanding speech. Yes --- No --- If yes, when? Before--- After--- diagnosis of your kidney disease
98
4. Sudden difficulty in walking, dizziness or loss of balance or coordination If yes when? Before--- After--- diagnosis of your kidney disease 5 Have you suffered from stroke before?
Yes--- No---
If yes, when? Before--- After--- diagnosis of your kidney disease 6. Have you been diagnosed of heart disease?
Yes --- No ---
If yes what type? Angina---MI---Heart failure ---Arrhythmias--- When? Before--- After--- diagnosis of your kidney disease
History of Medication
Are you taking medication for hypertension Yes---- No--- If yes which one Aldomet---- Moduretics--- Lasix---- Lisinopril/captopril/Ramipril--- HCT--- Losartan/Diovan--- Minoxidil --- Nifedipine/Amlodipine Apresoline--- Others ---
Have you been transfused in the last 3 months Yes--- No--- Are you on iron tablets/Have you taken iron drip in the last 3 months Has erythropoietin been prescribed for you
If yes at what dose Weekly --- 2x/Wk--- 3x/Wk How have you been taken it in the last 3 months ---
If you did not take it as prescribed why? I can’t buy it--- I don’t know--- I think what I’m taking is enough--- Other reasons---
99
Are you on medication to reduce serum lipids Yes --- No--- If yes what is the name ---
100 APPENDIX 11
CLINICAL ASSESSMENT FORM EXAMINATION AND INVESTIGATION
LVH
LVMI--- CCF
FRAMINGHAM CRITERIA Major Criteria
1 Paroxysmal nocturnal dyspnea Yes---- No--- 2. Lung crepitation Yes--- No--- 3. S3 Gallop Yes---- No--- 4. Radiographic evidence of cardiomegally Yes---- No---- 5 Raised jugular venous pressure Yes--- No---
Minor Criteria
6 Bilateral ankle oedema Yes--- No--- 7 Exertional dyspnea Yes--- No--- 8 Hepatomegally Yes--- No--- Hx of CCF from case notes Yes --- No --- Presence of CCF Yes--- No ---