Silent Myocardial Infarction in Asymptomatic Patients With End-Stage Renal Disease on Maintenance Hemodialysis in a Resource-Poor Setting: A Cross-Sectional Study From a Single Dialysis Center in Pakistan

Abstract

This descriptive cross-sectional study was conducted to determine the frequency of silent myocardial infarction (SMI) among asymptomatic end-stage renal disease (ESRD) patients on maintenance haemodialysis using routinely available electrocardiography and echocardiography in a resource-limited setting. The study was conducted at the Department of Nephrology, Dr. Ziauddin Hospital, Karachi, Pakistan, from April 2023 to October 2023. Medical records of 147 asymptomatic ESRD patients aged 18–70 years on maintenance haemodialysis for at least one year were reviewed. Patients with prior symptomatic ischaemic heart disease or coronary interventions were excluded. SMI was defined by pathological Q waves or major ST–T abnormalities on ECG (Minnesota Code) and/or regional wall motion abnormalities on echocardiography with left ventricular ejection fraction <50%, in the absence of ischaemic symptoms. Descriptive statistics, chi-square or Fisher’s exact tests, and multivariable logistic regression were applied. The mean age was 50.44 ± 13.55 years and 57.1% were male. SMI was identified in 19 patients (12.9%). Echocardiographic abnormalities were present in 43 patients (29.3%) and were not associated with SMI (p = 0.807). On multivariable analysis, haemodialysis duration greater than five years was independently associated with lower odds of SMI compared with one to five years (adjusted OR 0.11, 95% CI 0.01–0.84; p = 0.035). Silent myocardial infarction was identified in 12.9% of asymptomatic haemodialysis patients in this resource-limited setting. Routine ECG and echocardiography are feasible screening tools, particularly during the early dialysis period when cardiovascular risk appears greatest.