PREVALENCE AND MANAGEMENT OF CARDIORENAL SYNDROME IN DIABETIC PATIENTS PRESENTING TO THE NEPHROLOGY DIVISION AT KHYBER TEACHING HOSPITAL, PESHAWAR

Abstract

Background: Cardiorenal Syndrome (CRS) is a complex condition characterized by the interdependence of cardiac and renal dysfunction. In diabetic patients, this syndrome is prevalent due to the multifaceted impact of diabetes on both organ systems. Effective management of CRS requires a nuanced understanding of its prevalence and the development of targeted treatment strategies.

Aim: This study aims to investigate the prevalence of Cardiorenal Syndrome among diabetic patients presenting to the Nephrology Division at Khyber Teaching Hospital, Peshawar, and to evaluate the management approaches employed.

Methods: A cross-sectional analysis was conducted involving diabetic patients with documented cardiac and renal conditions. Data was collected from medical records and clinical evaluations conducted between July2023 to December 2023. Inclusion criteria encompassed diabetic patients with evidence of cardiac and renal dysfunction, while exclusion criteria included patients without complete records or those with non-diabetic etiologies of cardiac or renal disease. Statistical analysis was performed to assess prevalence rates and management practices.

Results: Of the 200 diabetic patients with Cardiorenal Syndrome (CRS) at Khyber Teaching Hospital, the most prevalent type was Type 2 (Chronic Cardio-Renal), affecting 60% of patients, with an average age of 68 years. This type was predominantly male (65%) and characterized by high rates of hypertension (95%) and poor glycemic control (85%). Type 4 (Chronic Reno-Cardiac) was observed in 25% of patients, often with advanced CKD stages and significant heart failure (80% in NYHA Class III/IV). Type 1 (Acute Cardio-Renal) and Type 3 (Acute Reno-Cardiac) were less common, affecting 10% and 5% of patients, respectively. Type 1 was associated with CKD Stage 3 or 4 and a substantial prevalence of low left ventricular ejection fraction (50%), while Type 3 had severe CKD with 70% having LVEF <40%. Type 5 (Secondary CRS) was not present in this cohort.Management strategies revealed that 70% of patients received ACE inhibitors, and 65% adhered to lifestyle modifications including dietary changes and exercise. The majority received coordinated care involving nephrologists and cardiologists (50%) and education on disease management (55%). Follow-up showed that 40% of patients had monthly visits to monitor their condition.

Conclusion: The high prevalence of Cardiorenal Syndrome among diabetic patients underscores the need for integrated management approaches. Effective treatment strategies should address both cardiac and renal dysfunctions simultaneously. This study highlights the importance of multidisciplinary care and ongoing research to optimize outcomes for patients with Cardiorenal Syndrome.