Les Cardiopathies chez le Patient en Insuffisance Rénale Terminale à l’Initiation de la Dialyse à Abidjan
Heart Disease in Patients with End-Stage Renal Disease at the Start of Dialysis in Abidjan
DOI :
https://doi.org/10.5281/hra.v2i11.6129Mots-clés :
Insuffisance rénale terminale, hypertrophie concentrique, hypertrophie excentrique, péricardite, AbidjanRésumé
RESUME
Introduction. En Côte d’Ivoire les cardiopathies urémiques représentent un facteur de morbidité et de mortalité au cours de l’insuffisance rénale. L’objectif de notre étude était de décrire l’état cardiaque des patientes à l’initiation de la dialyse. Méthodologie. Il s’agissait d’une étude prospective analytique réalisée sur une période de 3 ans allant de janvier 2016 à décembre 2018 dans les services de Néphrologie-Médecine interne D du CHU de Treichville et d’explorations fonctionnelles l’Institut de cardiologie d’Abidjan. Nous avons inclus tout patient âgé d’au moins 16 ans, hospitalisé pour une insuffisance rénale terminale et ayant réalisé une échographie cardiaque avant la dialyse ou moins de 15 jours après le début de l’hémodialyse. Résultats. Nous avons colligé 164 patients hémodialysés parmi lesquels 147 présentaient une cardiopathie urémique, soit une prévalence de 89,6%. L’âge moyen était de 39,31 ±14,89 ans pour un sex ratio de 1,53. Les antécédents les plus retrouvés étaient l’hypertension artérielle (73,5%) et la maladie rénale chronique (23,8%). Les principaux signes cliniques étaient la poussée hypertensive (89,8%), les œdèmes des membres inférieurs (73,5%), la pâleur cutanéomuqueuse (47,6%) et l’œdème aigu du poumon (43,5%). L’insuffisance rénale chronique était le type prédominant (93,9%). Les principales anomalies morphologiques à l’échographie cardiaque étaient l’hypertrophie ventriculaire gauche concentrique (57,1%), l’hypertrophie ventriculaire gauche excentrique (34%) et la péricardite (32%). Nous avons observé 40,8% de décès. Les facteurs de risque associés au décès étaient l’âge inférieur à 35 ans [p= 0,005 ; OR (IC 95%) = 2,56(1,32-4,95)] et la FEVG altérée [p=0,017 ; OR (IC 95%) = 2,17(1,14-4,11). Conclusion. La cardiopathie est fréquente à l’initiation de la dialyse et elle a une mortalité élevée. Une prise en charge précoce pourrait aider à améliorer le pronostic des patients.
ABSTRACT
Introduction. In Côte d'Ivoire, uraemic heart disease is a major cause of morbidity and mortality in renal failure. The aim of our study was to gain a better understanding of the cardiac status of patients at the start of dialysis. Methods. This was a prospective analytical study conducted over a 3-year period from January 2016 to December 2018 in the Nephrology-Internal Medicine D department of the Treichville University Hospital and the Functional Explorations department of the Abidjan Heart Institute. All patients aged at least 16 years, hospitalised for end-stage renal failure and who had undergone cardiac echocardiography before dialysis or less than 15 days after the start of haemodialysis were included. Results. We enrolled 164 haemodialysis patients, 147 of whom had uraemic heart disease, representing a prevalence of 89.6%. The mean age was 39.31 ±14.89 years, with a sex ratio of 1.53. The most common antecedents were arterial hypertension (73.5%) and chronic kidney disease (23.8%). The main clinical signs were hypertensive crisis (89.8%), oedema of the lower limbs (73.5%), mucocutaneous pallor (47.6%) and acute lung oedema (43.5%). Chronic renal failure was the predominant type (93.9%). The main morphological abnormalities on cardiac ultrasound were concentric hypertrophy (57.1%), eccentric hypertrophy (34%) and pericarditis (32%). We observed 40.8% deaths. The risk factors associated with death were age under 35 years [p=0.005; OR (95% CI) = 2.56(1.32-4.95)] and impaired LVEF [p=0.017; OR (95% CI) = 2.17(1.14-4.11)]. Conclusion. Heart disease is common at the start of dialysis and is associated with a high mortality rate. Early management could help improve patient prognosis.
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