The results of a recently published local study of chronic kidney disease shed new light on earlier findings about the risk of cardiovascular disease among people with kidney disease in South Africa.
The study, which was carried out as part of a doctoral thesis by nephrologist Dr Peter Hsu, who practices at Netcare Milpark Hospital, is the largest known study of its kind to date in South Africa.
Contrary to popular belief, black patients with kidney failure are at as high a cardiovascular risk as their white counterparts, a study has found.
“There are very few local studies on CKD, and with our specific set of population demographics, there was great potential for meaningful information that could help improve medical understanding and patient outcomes,” says Hsu.
“It was a very rewarding opportunity to work with patients who already knew me well, as it meant patients had more confidence in the research; and patients returned for subsequent sessions, which greatly aided in gathering more conclusive data.
“Kidney patients are at high risk of heart attack and stroke, but black kidney patients were previously thought to have a lower risk of cardiovascular problems than white kidney patients in South Africa due to various intrinsic and extrinsic factors. »
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Hsu says the study found that cardiovascular risk is actually equal between the two racial groups and that the cardiovascular burden is very high in both.
“We also noticed that white kidney patients were more likely to suffer from atherosclerosis, which is a build-up of fat and other deposits on artery walls that can limit blood flow over time,” says Hsu.
“Black kidney patients, on the other hand, are more likely to suffer from atherosclerosis, which is the hardening and thickening of the blood vessels that carry oxygen and nutrients from the heart to other parts of the body — leading to higher blood pressure.”
Hsu says the results of his academic research, which was conducted in private practice, were published earlier than he expected, with five separate articles appearing in five international journals. He received his certificate of completion for this doctorate at Wits University’s Mandela Day Doctoral Awards Ceremony.
“It was a very significant day for me, not only because I received my doctorate, but also because I knew Madiba very well, so the ceremony took place on this day. It felt like a continuation of the circle of life.”
Hsu has been in private practice for 25 years, 20 of which he spent treating patients with chronic kidney disease at Netcare Milpark Hospital. He began this doctoral work five years ago under the supervision of Professor Patrick Desain, Principal Professor of the Wits Schools of Medicine and Physiology.
“With approval from the Netcare ethics committee, we were able to recruit participants from Netcare Milpark Hospital and some other dialysis units. We had a total of 200 participants, which meant that this was the largest study of kidney patients that we know of in South Africa.
“Of the 201 patients I approached, only one refused to participate for personal reasons. The remaining 200 patients were eager to be a part of something that could help other CKD patients.
“We included the full spectrum of CKD patients, of which 33% have CKD but are not yet on dialysis, 33% are on dialysis and 33% have had a kidney transplant,” says Hsu.
“Specific risk factors that were identified included arterial stiffness, anemia, diastolic dysfunction, in which the heart muscle becomes stiff, and parathyroid hormone, which is little known but, when elevated, has a significant impact on cardiovascular risk after a kidney transplant.
“A PhD is a huge commitment, especially along with the many other responsibilities you have when you are a doctor in private practice.
“It is also not easy to return to academic training after so many years, but on the other hand, as a more experienced doctor, you have a clearer vision of what you want to achieve with this kind of research.
“Professor Desain really inspired me to take this step and helped me to see that it was possible, so I sincerely thank him for his supervision and invaluable guidance that helped me complete this research.”
Hsu says he’s also “very grateful” for the support and help he’s received from his colleagues.
“For example, there were some practical applications from other medical disciplines, such as echocardiography, which I studied remotely at the University of Vienna specifically for my doctorate. But having an experienced hand guiding me through the scan greatly reduced the training time.”