Silent Myocardial Ischemia in CKD Stage 3-5: Prevalence and Predictors

TL;DR

This study finds that nearly 37% of patients with advanced chronic kidney disease have silent heart problems, with age, diabetes, and other factors increasing the risk.

Contribution

The study identifies novel independent predictors of silent myocardial ischemia in CKD stage 3-5 patients, including elevated parathyroid hormone levels.

Findings

Silent myocardial ischemia was present in 37.4% of CKD stage 3-5 patients.

Diabetes mellitus and left ventricular hypertrophy were strong predictors of SMI.

Elevated parathyroid hormone levels were independently associated with SMI.

Abstract

Background: Silent myocardial ischemia (SMI) is a major but often underdiagnosed cardiovascular complication in patients with chronic kidney disease (CKD), particularly in advanced stages.

Objective: This study aims to determine the prevalence of silent myocardial ischemia and identify its clinical and biochemical predictors among patients with CKD stage 3-5.

Methods: This was a cross-sectional analytical study conducted at Allama Iqbal Medical College, Lahore, Pakistan, from January 2024 to December 2024. Data were collected using a structured questionnaire specifically designed for this study. Demographic information such as age, gender, and body mass index (BMI) was recorded for each participant.

Results: The prevalence of silent myocardial ischemia was found to be 37.4% (n = 89) in the study population. Patients with SMI were significantly older (mean age: 61.2 ± 10.5 years) compared to those without SMI (mean age: 57.1 ± 11.3 years) (p = 0.01). Diabetes mellitus was present in 82% of patients with SMI compared to 57.3% of those without (p < 0.001). Left ventricular hypertrophy (LVH) was observed in 55% of patients with SMI versus 31.4% of patients without SMI (p = 0.002). Elevated parathyroid hormone levels (>150 pg/mL) were seen in 73% of patients with SMI compared to 61% of patients without SMI (p = 0.047). Logistic regression analysis identified age > 60 years (adjusted odds ratio (AOR): 2.1; 95% confidence interval (CI): 1.2-3.5), diabetes mellitus (AOR: 2.9; 95% CI: 1.6-5.3), left ventricular hypertrophy (AOR: 2.4; 95% CI: 1.3-4.3), and elevated parathyroid hormone (PTH) levels (AOR: 1.8; 95% CI: 1.0-3.2) as independent predictors of SMI.

Conclusion: Silent myocardial ischemia is common in patients with CKD stage 3-5 and is independently associated with age, diabetes mellitus, left ventricular hypertrophy, and elevated PTH levels. Routine screening for SMI in high-risk patients with CKD is warranted to enable early detection and prevention of major cardiovascular events. Future longitudinal studies are recommended to assess the long-term impact of such screening and intervention strategies.

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