KAIMOSI FRIENDS UNIVERSITY

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF NURSING
PREVALENCE OF CARDIOVASCULAR DISEASES AMONG PERSONS
WITH RENAL DSYFUNCTION ATTENDING VIHIGA COUNTY
HOSPITAL
PRESENTED BY:
ELIMELDAH .B. TWARA HNR/0037/2022
BILLY .N. ELKANAH HNR/5002/2022
VICTOR .O. ODHIAMBO HNR/5009/2022
GAIL .K. MOGWASI HNR/0044/2022

A RESEARCH PROPOSAL WRITTEN IN PARTIAL FULFILMENT OF

THE REQUIREMENTS FOR THE COURSE NCN 317 RESEARCH
METHODOLOGY

LECTURER DR. VINCENT OKENWA

JULY 2024

PREVALENCE OF CARDIOVASCULAR DISEASES AMONG PERSONS

WITH RENAL DSYFUNCTION ATTENDING VIHIGA COUNTY
HOSPITAL

1
PRESENTED BY:
ELIMELDAH .B. TWARA HNR/0037/2022
BILLY .N. ELKANAH HNR/5002/2022
VICTOR .O. ODHIAMBO HNR/5009/2022
GAIL .K. MOGWASI HNR/0044/2022

DEPARTMENT OF NURSING,KAIMOSI FRIENDS

UNIVERSITY,VIHIGA COUNTY

Declaration by the Candidates

We declare that this research project is our original work and has not been
presented to any other University for a similar or any other degree award.
No part of this work should be produced without our consent or Kaimosi
Friends University
Student names Sign Date
Elimeldah twara ……………. …………..
Billy elkanah ……………. …………….
Victor odhiambo ……………… …………….
Gail mogwasi ……………… ……………..

APPROVAL
This research proposal has been submitted for examination with approval
as university supervisor
Supervisor sign date
Dr okenwa-vincent ……………… ……………..
Kaimosi friends university

2
DEDICATION
We dedicate this research proposal to all persons with cardiovascular diseases,
our supervisor,our nursing lecturers and our family for the support and
encouragement they gave us during the research period.
ACKNOWLEDGEMENT
The preparation of this was a challenging time in our lives. We would not have
succeeded in anything without God who made everything possible. We owe it
all to Him. Our sincere gratitude goes to Dr Okenwa, our supervisor; for his
dedicated supervision, constructive criticism, instructions, and his patience.
We wish to thank our colleagues and classmates who encouraged and gave us
moral support, all the lecturers and instructors in the Department of nursing who
have graciously taken us through the course.
Lastly, special thanks go to our families for their moral support

3
TABLE OF CONTENTS
DECLARATION …………..…………………………………………………..ii
ACKNOWLEDGEMENT………………………………………………...… iii
TABLE OF CONTENTS…………………………………………………….. iv
List of Tables……………………………………………………...…………. vii
List of Figures…………………………………………………...………….. viii
ABSTRACT…………………………………………………………………. ix
CHAPTER ONE
1INTRODUCTION……………………………….………………………….. 1
1.0Background information……………….…………………………………. 1
1.1Problem Statement………………………………...………………………. 5
1.2 Aim of study………………..………………..…………………………… 5
1.3 Research objectives………….………………………………………… 6
1.4 Research questions………….…………………………………………. 7
1.5 Significance of study………………………………….………………… 7
1.6 Scope of study…………………….…………………………………….. 7
CHAPTER TWO
2 LITERATURE REVIEW………………………………………………. 12
2.0 Background ……………………………………………………………..12
2.1 Prevalence of Cardiovascular disease among persons with renal
dysfunctions ………………………………………………………………...14
2.2 Types of Cardiovascular disease among persons with renal
dysfunctions………………………………………………………………… 15
2.3 Demographic, clinical, and lifestyle factors associated with increased
risk of Cardiovascular disease…………………….……………………... 17
2.4 Relationship between cardiovascular diseases and renal function .
…………………………………………………………...……………………18
2.5 Gaps in knowledge ………………..……………………………………18
2.6 Conclusion……………….…………………………………………….. 19

4
CHAPTER THREE
RESEARCH METHODOLOGY……………….……………………… …20
3.1 Introduction……………………………………………………………..20
3.2 Study Area…………………………………………………………… …20
3.3 Study Population………………………………………………………..20
3.31 Inclusion criteria……………….……………………………………20
3.32 Exclusion criteria……………….…………………………………...20
3.4 Study Design……………….……………………………………………20
3.5 Description of methods
3.5.1Sample Size Determination..……………..……………………………21
3.5.2 Sampling Technique……………………..……...…………….……… 21
3.6Data Collection Techniques………………………………………….……21
3.6.1 Instruments For Data Collection……………..………………………21
3.6.2 Summary Of Methods……………...…………………………………21
3.6.3 Techniques For Validation Of Instruments……………….…………22
3.7 Data Management,Analysis and Presentation………………….………22
3.7.1 Data Storage and Management……………...………………………23
3.7.2Data Analysis and Presentation……………….………………..…….23
3.8 Ethical Considerations…………………..……………….………………23
3.9 Expected Findings…………………..……………………………………24
3.10 Conclusion………………………………………………………………24
References ……………………………………………………………………24

5
ABBREVIATIONS
CKD – Chronic kidney disease
CVD – Cardiovascular disease
CKM – Cardiovascular-kidney-metabolic
ESRD – End stage renal disease
IHD – Ischemic heart disease
PAD – peripheral arterial disease
AKI – Acute kidney injury
DEFINITION OF TERMS
Chronic kidney disease - long-term condition characterized by a gradual loss
of kidney function over time. It is defined by the presence of kidney damage or
a decreased glomerular filtration rate (GFR) lasting for three months or more.
Cardiovascular disease- a broad term encompassing a range of conditions that
affect the heart and blood vessels.
ABSTRACT
Background
Cardiovascular disease (CVD) and renal dysfunctions are closely interlinked,
sharing common risk factors such as hypertension, diabetes, and dyslipidemia.
The coexistence of these conditions significantly increases morbidity and
mortality among affected individuals. This study aims to assess the prevalence
of cardiovascular disease among patients with renal dysfunctions attending
Vihiga County Hospital in Kenya.
Objectives
The primary objective is to determine the prevalence of CVD among patients
with renal dysfunctions at Vihiga County Hospital.
Methods
A cross-sectional descriptive study design will be used. The study population
will consist of adult patients (aged 18 and above) diagnosed with renal
dysfunctions (including chronic kidney disease, acute kidney injury, and end-
stage renal disease) who attend Vihiga County Hospital. A systematic random

6
sampling technique will be employed to select participants. Data will be
collected through structured questionnaires, medical records, and relevant
laboratory assessments. Statistical analyses will include descriptive statistics to
summarize demographic and clinical data, and logistic regression to explore
associations between renal dysfunction and CVD.
Results
The findings are expected to reveal the prevalence of CVD among patients with
renal dysfunctions and highlight significant demographic and clinical factors
contributing to this comorbidity. This data will provide a basis for improving
integrated care strategies for patients with these conditions.
Conclusion
By elucidating the prevalence and characteristics of CVD in patients with renal
dysfunctions at Vihiga County Hospital, this study aims to contribute to better
healthcare planning and resource allocation. The outcomes will help inform
targeted interventions to reduce the burden of cardiovascular disease in this
high-risk population, ultimately improving patient outcomes and quality of life.

CHAPTER ONE
1.0 BACKGROUND INFORMATION

7
Cardiovascular diseases (CVD) is a significant health concern globally and its
prevalence is notably higher among individuals with renal dysfunctions such as
chronic kidney disease (CKD) and end stage renal disease (ESRD).
CVD and CKD are closely interlinked, with each condition exacerbating the
other.
This report delves into the prevalence of cardiovascular disease among
individuals with renal dysfunction, specifically those attending Vihiga County
Hospital in Kenya(Vihiga county government 2019). This study provides a
comprehensive understanding of the epidemiology, risk factors, and
implications of these coexisting conditions.
The prevalence of CKD in sub-Saharan Africa, including Kenya, is significant.
A study estimated the overall prevalence of CKD to be 13.6% in a population
sample, with varying degrees of severity (Naicker ,S. 2021).
In rural East Africa, the prevalence of CKD was found to be 6.8%, with regional
variations, including a 3.7% prevalence in western Kenya (Kidney disease
2013)
This indicates a substantial burden of CKD in the region, necessitating targeted
healthcare interventions.
According to the national kidney foundation, several risk factors are associated
with CKD, including hypertension, diabetes, infectious diseases such as
tuberculosis and schistosomiasis, age, particularly above 50 years, and longer
duration of diabetes are significant determinants of CKD. These risk factors
highlight the need for comprehensive screening and management strategies in
populations at risk.
Cardiovascular diseases are a leading cause of morbidity and mortality among
CKD patients. Studies have shown that the prevalence of CVD in CKD patients
is alarmingly high.

8
For instance, 56.3% of CKD patients at King Abdulaziz University Hospital
were diagnosed with CVD, with congestive heart failure and ischemic heart
disease being the most common types(Alsuwaida A.O et al 2011) .
This underscores the critical need for cardiovascular risk assessment in CKD
management.
CKD and CVD share many common risk factors, such as hypertension and
diabetes, which contribute to the high prevalence of CVD in CKD patients.
The presence of CKD significantly increases the risk of cardiovascular events,
and vice versa, creating a vicious cycle that exacerbates both conditions.
This interrelationship has led to the concept of cardiovascular-kidney-metabolic
(CKM) syndrome, emphasizing the interconnected nature of these diseases.
Hypertension is a major contributor to both CKD and CVD. The prevalence of
hypertension in Africa ranges from 25% to 35% in adults aged 25 to 64 years.
(national kidney foundation 2020)
In Kenya, there is a high prevalence of undetected hypertension, particularly in
urban slum communities, which is associated with increased cardiovascular
risk.(Kenya national bureau of statistics 2019)
Effective management of hypertension is crucial in reducing the burden of both
CKD and CVD.
The high prevalence of CKD and its strong association with CVD in the region
necessitates a multifaceted approach to healthcare. This includes:
Screening and Early Detection: Regular screening for CKD and CVD risk
factors, especially in high-risk populations, can facilitate early intervention and
management.
Integrated Care Models: Implementing integrated care models that address both
CKD and CVD can improve patient outcomes and reduce healthcare costs .
Public Health Interventions: Raising awareness about the risk factors and
promoting lifestyle changes, such as healthy diets and physical activity, can help
mitigate the prevalence of these conditions.

9
The prevalence of cardiovascular disease among persons with renal dysfunction
attending Vihiga County Hospital is a significant public health concern.
1.1 PROBLEM STATEMENT
CVD is a leading cause of morbidity and mortality worldwide, with persons
with renal dysfunction being at an even higher risk of developing CVD. Vihiga
County Hospital, a major referral hospital in western Kenya, serving a
substantial rural population in Kenya, faces significant challenges in managing
chronic diseases (Vihiga county government 2020). The burden of CKD and its
cardiovascular implications in this setting is likely influenced by limited
healthcare resources, socio-economic factors, and a high prevalence of risk
factors such as hypertension and diabetes.
Despite this, there is a lack of data on the prevalence of CVD among patients
with renal dysfunction attending the hospital. This lack of information hinders
effective prevention and management strategies for CVD in this high-
risk population.
According to the National Kidney Foundation, CVD is the leading cause of
death in patients with CKD, accounting for 40-50% of all deaths in this
population. This heightened risk is attributed to factors such as hypertension,
dyslipidemia, and increased levels of inflammatory markers commonly seen in
CKD patients.
The prevalence of cardiovascular disease among persons with renal
dysfunctions is alarmingly high. CKD affects approximately 15-20% of adults
globally, and these individuals are at a significantly increased risk of various
cardiovascular outcomes, including coronary disease, stroke, peripheral artery
disease, arrhythmias, and heart failure.
This elevated risk is due to shared risk factors such as hypertension and
diabetes, altered bone mineral metabolism, anemia, volume overload, and the
presence of uremic toxins. In patients with ESRD, cardiovascular diseases are
the leading cause of death, with hypertension exacerbating complications such

10
as left ventricular hypertrophy, cardiac chamber dilation, and myocardial
fibrosis.
Failing to address the high prevalence of CVD in individuals with renal
dysfunctions has severe consequences. These include increased mortality rates,
reduced quality of life, and higher healthcare costs due to frequent
hospitalizations and complex treatment regimens.
The burden on healthcare systems is substantial, and the negative implications
extend to patients' families and caregivers, who often face emotional and
financial stress.
Despite the known association between renal dysfunctions and cardiovascular
disease, there are inconsistencies in clinical guidelines regarding the
incorporation of CKD measures for CVD risk prediction.
This gap in knowledge and practice hinders the development of effective
prevention and management strategies. Additionally, the complexity of the
condition makes it challenging to determine the incidence of coronary artery
disease in ESRD populations, further complicating risk assessment and
treatment.
The high prevalence of cardiovascular disease among persons with renal
dysfunctions represents a significant public health challenge. Addressing this
issue requires consistent clinical guidelines, improved risk prediction models,
and a multidisciplinary care approach to manage the intertwined health
challenges effectively. Further research and innovative approaches are essential
to enhance the cardiovascular health outcomes of patients with CKD and ESRD.

1.2 RESEARCH AIM

To determine the prevalence of cardiovascular diseases among persons with
renal dysfunctions attending Vihiga County Hospital and identify associated
risk factors and current management practices.
1.3 RESEARCH OBJECTIVES

11
1. To identify the types of cardiovascular diseases most commonly associated
with renal dysfunction in this patient population
2. Identify demographic, clinical, and lifestyle factors associated with
increased risk of CVD in these patients.
3. To evaluate the relationship between cardiovascular disease and renal
function in patients with chronic kidney disease (CKD).
1.4 Research Questions
1. What is the prevalence of cardiovascular diseases among patients with renal
dysfunctions attending Vihiga county hospital?
2. What are the types of cardiovascular diseases among patients with renal
dysfunctions attending Vihiga County Hospital?
3. What are the common risk factors associated with cardiovascular diseases in
these patients?
4. What is the relationship between cardiovascular disease and renal function in
patients with chronic kidney disease (CKD)?

1.5 Significance of the Study

The findings from this research will provide critical insights for healthcare
providers and policymakers in Vihiga County. By understanding the prevalence
and associated risk factors of CVD in patients with renal dysfunction, targeted
interventions can be developed to improve patient outcomes. Moreover,
evaluating current management strategies will highlight areas needing
improvement, ensuring more effective and efficient healthcare delivery.
1.6 SCOPE OF STUDY
This study aims to assess the prevalence of CVD among individuals with renal
dysfunctions attending Vihiga County Hospital. The research will explore the
relationship between renal dysfunction and the occurrence of CVD, providing
insights into the burden of CVD within this specific population. The findings

12
will inform healthcare practices and interventions aimed at managing and
preventing CVD among patients with renal dysfunctions.
CHAPTER TWO
LITERATURE REVIEW
2.0 Background
CVD is a leading cause of morbidity and mortality worldwide, and its
prevalence is particularly high among individuals with renal dysfunction.
Vihiga County Hospital, a major healthcare facility in western Kenya, has
reported a growing trend of CVD among its patients with renal dysfunction.
This literature review aims to summarize the existing evidence on the
prevalence, types, and risk factors of CVD among persons with renal
dysfunction attending Vihiga County Hospital.
2.1 Prevalence of Cardiovascular disease among persons with renal
dysfunctions
Studies have consistently shown that individuals with chronic kidney disease
are at increased risk of developing CVD. A systematic review of 23 studies
published in the Journal of the American Society of Nephrology found that the
prevalence of CVD ranged from 35% to 84% among patients with CKD (Go AS
et al 2013).
Another study conducted in Kenya found that 62% of patients with CKD had
hypertension, which is a major risk factor for CVD (Mwangi TW et al 2015).
CVD is a major cause of morbidity and mortality among patients with renal
dysfunction. Studies have shown a significantly higher prevalence of CVD in
individuals with chronic kidney disease (CKD) compared to the general
population.
A systematic review by (Go et al. 2004) found that individuals with CKD have
a markedly higher risk of cardiovascular events, including myocardial
infarction, stroke, and heart failure.

13
Several studies have reported a high prevalence of CVDs among patients with
renal dysfunction. A study conducted in Nairobi, Kenya, found that 64.4% of
patients with CKD had a history of hypertension, 44.8% had a history of
diabetes, and 31.9% had a history of CVDs (Macharia WO et al. (2018).
Another study in western Kenya found that 75% of patients with CKD had
hypertension, 35% had diabetes, and 25% had CVDs (Ouma J et al. (2017).
Furthermore, the prevalence of CVD increases with the severity of renal
dysfunction. In Kenya, data specific to Vihiga County is limited, but the trends
mirror global findings, with a substantial burden of CVD observed among CKD
patients.
2.2 Types of Cardiovascular disease among persons with renal dysfunctions
The most common types of CVD among individuals with renal dysfunction are
coronary artery disease, peripheral artery disease, and heart failure.
A study published in the Journal of Cardiology and Cardiovascular Therapy
found that coronary artery disease was present in 55% of patients with CKD,
while peripheral artery disease was present in 30% (Zoccali C et al 2017).
Heart failure was another common complication, occurring in 25% of patients
(Zoccali C et al 2017).
The most common CVDs among these patients include:
- Ischemic Heart Disease (IHD): Characterized by reduced blood supply to the
heart muscle, leading to angina or myocardial infarction. A study conducted in
Egypt found that ischemic heart disease was the most common CVD among
patients with CKD, accounting for 45.5%of cases (Abdel-Rahman et al 2017)
- Heart Failure: Often resulting from the combination of hypertension, left
ventricular hypertrophy, and fluid overload. A study conducted in Europe found
that cardiac failure was a common complication of CKD, affecting 15.4% of
patients (de Boer et al., 2017).
- Arrhythmias: Including atrial fibrillation, which is more prevalent due to
electrolyte imbalances and structural heart changes. (Genovesi et al 2005)

14
- Peripheral Arterial Disease (PAD): A condition marked by narrowing of
peripheral arteries, often leading to claudication and critical limb ischemia.
Higher incidence due to similar atherosclerotic processes affecting peripheral
arteries (O’Hare et al 2004)
- Cerebrovascular Disease: Encompassing stroke and transient ischemic attacks,
which are more common due to the shared risk factors of hypertension and
atherosclerosis.
2.3 Demographic, clinical, and lifestyle factors associated with increased
risk of Cardiovascular disease
Several demographic, clinical, and lifestyle factors have been identified as risk
factors for CVD among individuals with renal dysfunction. These include:
Age: Older age is a significant risk factor for CVD (Fried LF et al 2011). A
study conducted in Egypt found that age was a significant predictor of CVD
among patients with CKD, with older patients being at higher risk (Abdel-
Rahman et al., 2017).
Gender: Men are more likely to develop CVD than women (Hsu CY et al 2010).
A study conducted in India found that sex was a significant predictor of CVD
among patients with CKD, with men being at higher risk than women (Gupta et
al., 2018).
Ethnicity: Certain ethnic groups may be at higher risk of CVD (Go AS et al
2013). A study conducted in the United States found that ethnicity was a
significant predictor of CVD among patients with CKD, with African
Americans being at higher risk than whites (Cohen et al., 2017)
Family history: A family history of CVD increases the risk of developing CVD
(Pfeffer MA et al 2015)
Renal function: Decreased renal function is a strong predictor of CVD risk
(Levey AS et al 2004)
Hypertension: Uncontrolled hypertension is a major risk factor for CVD (James
PA et al 2017)

15
Diabetes: Presence of diabetes mellitus increases the risk of CVD (American
diabetes association 2018)
Smoking: Smoking is a significant risk factor for CVD (US department of
health and human service centers for disease control and prevention office on
smoking and health)
2.4 Relationship between cardiovascular diseases and renal function
The relationship between CVDs and renal functions is bidirectional. Chronic
kidney disease is a known risk factor for CVDs, and conversely, CVDs can also
lead to kidney damage. A study published in the Journal of the American
Society of Nephrology found that patients with CKD had a higher risk of
developing CVDs compared to those without CKD (Go AS et al. (2004).
Another study published in the Journal of Cardiology found that patients with
CVDs had a higher risk of developing CKD compared to those
without CVDs (Navaneethan SD et al. (2018).
Gaps in current knowledge
Despite the high prevalence of CVD in CKD patients, there are several gaps in
current knowledge that need to be addressed. These include:
Limited data on CVD prevalence in specific regions: There is limited data on
the prevalence of CVD in CKD patients from specific regions, including Vihiga
County.
Limited understanding of risk factors for CVD in CKD patients: While several
risk factors have been identified for CVD in CKD patients, there is still limited
understanding of the underlying mechanisms and how these factors interact with
each other.
Conclusion
In conclusion, individuals with renal dysfunction attending Vihiga County
Hospital are at high risk of developing cardiovascular disease. The prevalence
and types of CVD among this population are consistent with those reported in
other studies. Demographic, clinical, and lifestyle factors contribute to the

16
increased risk of CVD. Current management strategies, including intensive
blood pressure control and statin therapy, show promise in mitigating
cardiovascular risk. Further research is needed to develop more effective
prevention and treatment strategies for this high-risk population

CHAPTER THREE
RESEARCH METHODOLOGY
3.1 INTRODUCTION
This chapter has provided valuable information that will be used to enable the
study objectives be met. In this chapter, we have outlined the research designs,
data collection methods, sampling strategies and data analysis's techniques
employs in this study. Data collection methods included use of questionnaires
and interviewing. Sampling was purposive, targeting a cohort of individuals
across the region. Ethical considerations including informed consent and
confidentiality are addressed throughout the research process. Data analysis
involves statistical techniques for data survey

3.2 STUDY AREA

The study will be conducted at Vihiga County Hospital, located in Vihiga
County, Western Kenya. The hospital serves as a primary healthcare provider
for the county and surrounding regions. This hospital serves a large population,
making it an ideal location for the study.
3.3 STUDY POPULATION
The study population will consist of patients attending Vihiga County Hospital
who have been diagnosed with renal dysfunctions, including both chronic
kidney disease (CKD) and acute kidney injury (AKI). This population is chosen
due to the high prevalence of cardiovascular disease (CVD) among individuals
with renal dysfunctions, as evidenced by various studies.

17
3.3.1 INCLUSION CRITERIA
Patients with confirmed renal dysfunction (chronic kidney disease, acute kidney
injury, or end-stage renal disease).
Definite CKD patients aged 18 years and above and whose serum creatinine
results were available and not older than one month. Also, these patients must
have consented to participate in the study.
Only nephrologists and nephrology nurses who had worked in the nephrology
clinics for at least 3 months were included in the study as they were able to give
information on risk factors and factors influencing management of CKD.
Should be residing in Vihiga County.
3.3.2 EXCLUSION CRITERIA
Mentally and critically ill patients as well as successful kidney transplant
recipients who were attending nephrology clinic were excluded.
Patients with acute kidney injury caused by surgical complications or trauma.
Patients with chronic kidney disease on hemodialysis.
Patients with incomplete medical records
3.4 STUDY DESIGN
The study will employ a cross-sectional descriptive design. This design is
appropriate for determining the prevalence of CVD among patients with renal
dysfunctions at a specific point in time, providing a snapshot of the current
situation.
3.5 DESCRIPTION OF METHODS
3.5.1 SAMPLE SIZE DETERMINATION
The sample will be determined using Fisher’s Method as cited in Kothari,
(2004).
n0= p2zq/e2
Where;
n0= required sample size,

18
P= estimated proportions of CKD among outpatients =0.39 (based on
prevalence reported
by Kore & Yohannes, (2018) study, in Ethiopia),
z=standardized normal deviate for 95% CI =1.96
q= 1-p,
e= desired error margin =0.05
Then, n= (1.96)2*0.39*0.61/ (0.05)2 =366

3.5.2 SAMPLING TECHNIQUE

To obtain a representative sample, a combination of random sampling and
stratified sampling techniques will be employed.
Random sampling will be used to select a subset of individuals from the entire
population of persons with renal dysfunction attending Vihiga County Hospital.
This technique will ensure that each individual in the population has an equal
chance of being selected for the study. Random sampling will be conducted by
assigning a unique identification number to each individual in the population
and then using a random number generator to select the desired sample size.
Stratified sampling will be used to ensure that the sample represents different
subgroups within the population. In this case, the subgroups will be defined
based on factors such as age, gender, and severity of renal dysfunction.
Stratified sampling will involve dividing the population into homogeneous
groups (strata) and then randomly selecting individuals from each stratum in
proportion to their representation in the population. This technique will ensure
that each subgroup is adequately represented in the sample.
3.6 DATA COLLECTION TECHNIQUES
3.6.1 DATA COLLECTION PROCESS
Data will be collected using a combination of methods to ensure comprehensive
and accurate information:

19
Medical Records Review: Retrospective review of medical records to collect
demographic data, medical history, and laboratory results.
Clinical Examination: Conducted by trained healthcare professionals to assess
current health status and presence of CVDs.
Questionnaires: Administered to patients to gather information on lifestyle
habits, family history, and personal health perceptions.
Laboratory Tests: To confirm renal function and screen for CVD risk factors
such as cholesterol levels and blood pressure.
3.6.2 Data Collection Instruments
Medical Records: Data will be extracted regarding diagnosis, treatment history,
medication usage, and outcomes.
Questionnaires: Structured questionnaires designed to collect information on
lifestyle factors, dietary habits, and family medical history.
Clinical Examination Forms: Documentation of clinical findings, including
signs of CVDs.
Laboratory Test Results: Records of blood tests, urine analysis, and other
relevant tests.
3.6.3 Techniques for Validation of Instruments
The validity of the instruments for data collection for our study will be done
through expert judgement, face validity and pilot testing.
Face validity is the assessment of whether an instrument appears on its face to
measure what its intended to measure.
Pilot study will be done and any correction found will be made accordingly in
relation to the study topic. The results of the pilot study will not be included in
the final findings of the research.
For expert judgement, three or more lecturers should revies the instrument and
agree if its appropriate for a particular situation.
pretesting questionnaires on a small sample of patients to ensure clarity and
reliability.

20
3.6.4 Summary of methods
We will obtain ethical approval from the relevant committee and train the
healthcare professionals on the data collection procedures.
We will screen the patients for eligibility of participation in the research.
We will collect data using structured questionnaires and review of medical
records.
3.7 Data Management, Analysis and presentation
3.7.1 Data Management and Storage
Data collected will be recorded into Google sheets 2021 and used to examine
the variables under study.
The whole data under the management of the researcher will be stored,
managed and applied.
For the electronic data, the data will be stored in an encrypted form with access
only to the researchers.
The hard data will be stored in the nursing library for a few years before it being
destroyed.

3.7.2 Data Analysis and Presentation

Raw data gathered will be recorded in a google sheet. We will check for any
missing values, outliers or inconsistencies and clean the dataset ensuring data
integrity.
Data will be coded then transported to an efficient statistical tool e.g. SPSS for
accurate analysis.
The results obtained will be presented in various forms including tables, graphs,
charts and measures of central tendency.
Data analysis will involve applying appropriate statistical methods to analyze
the collected data. This may include descriptive statistics, inferential statistics,

21
and potentially multivariate analysis techniques. The results will be presented
using tables, graphs, and other visual aids to illustrate the findings.
Chi-square tests will be used to identify associations between renal dsyfunction
and CVD
3.8 Ethical Consideration
This study will consider ethical issues into account.
These will include: Obtaining an informed consent, information confidentiality,
voluntary participation, anonymity, right to withdraw, physical or psychological
harm and deception and debriefing.
We will seek permission from the Dean of Students regarding approval of the
study.
The informed consent will be appropriately documented.
we will give the participants a document explaining to them what will be
needed of them and the potential risks.
The participants will not be forced to participate in research if the study brings
harm to them
3.9 EXPECTED FINDINGS
The study is expected to provide valuable insights into the prevalence of CVD
among individuals with renal dysfunctions attending Vihiga County Hospital.
The findings will contribute to existing knowledge on the relationship between
renal dysfunction and CVD, informing future healthcare practices and
interventions aimed at managing and preventing CVD in this population
3.10 Conclusion
In summary, this chapter has provided a detailed overview of methodological
choices made to investigate the research questions. The findings from this study
are expected to inform healthcare practitioners and policy makers on the
strategies for managing cardiovascular disorders among renal failure patients.

References

22
 Abdel-Rahman, E., Abdel-Hady, M., & Hassan, A. (2017). Prevalence and
predictors of cardiovascular disease among patients with chronic kidney
disease stage III-V: A cross-sectional study. Journal of Clinical Medicine
Research, 9(1), 43-51.
 American Diabetes Association. Standards of medical care in diabetes—
2018. Diabetes Care 2018;41(Suppl 1): S1-S193.
 Cohen, S. D., & Toto, R. D. (2017). Cardiovascular disease in patients with
chronic kidney disease: A review. Journal of the American Society of
Nephrology, 28(5), 1411-1420.
 de Boer, I. H., & Kovesdy, C. P. (2017). Cardiovascular disease in patients
with chronic kidney disease: A review. Journal of the American Society of
Nephrology, 28(5), 1421-1430.
 Fried LF et al. Chronic kidney disease and mortality risk: A systematic
review. J Am Soc Nephrol 2011;22(2):239-246.
 Genovesi, S., et al. (2005). Prevalence of atrial fibrillation and associated
factors in hemodialysis patients. American Journal of Kidney Diseases,
46(5), 897-902.
 Go AS et al. (2004). Chronic kidney disease and cardiovascular disease: A
systematic review. American Journal of Kidney Diseases, 44(5), 844-857.
 Go AS et al. Chronic kidney disease and cardiovascular disease: A
systematic review. J Am Soc Nephrol 2013;24(11):1724-1735.
 Gupta, R., Kumar, V., & Kumar, P. (2018). Prevalence and predictors of
cardiovascular disease among patients with chronic kidney disease stage III-
V: A cross-sectional study from India. Journal of Clinical Medicine
Research, 10(2), 131-138.
 Hsu CY et al. Racial disparities in cardiovascular outcomes among patients
with chronic kidney disease. J Am Soc Nephrol 2010;21(10):1798-1806.
 James PA et al. 2017
ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/PCNA guideline for the
prevention, detection, evaluation, and management of high blood pressure in
adults: Executive summary. J Am Coll Cardiol 2017;70(6):1043-1054.
 Kenya National Bureau of Statistics. (2019). Kenya Demographic and
Health Survey 2014
 Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.
(2013). KDIGO clinical practice guideline for the evaluation and
management of chronic kidney disease. Kidney International, 83(1), e1-
e155.
 Levey AS et al. KDOQI clinical practice guideline for chronic kidney
disease: Evaluation, classification, and stratification. Am J Kidney Dis
2004;43(Suppl 1): S1-S247.
 Macharia WO et al. (2018). Prevalence and predictors of chronic kidney
disease in a Kenyan population. Kidney International Reports, 3(3), 341-348.

23
 Mwangi TW et al. Prevalence and predictors of hypertension in patients
with chronic kidney disease at Kenyatta National Hospital, Nairobi. East Afr
Med J 2015;92(11):344-351.
 Naicker, S. (2021). The epidemiology of chronic kidney disease and the
association with non-communicable and communicable disorders in a
population of sub-Saharan Africa
https://doi.org/10.1371/journal.pone.0241874
 National Kidney Foundation. (2023). Cardiovascular Disease in Chronic
Kidney Disease. Retrieved from NKF Website.
 Navaneethan SD et al. (2018). Chronic kidney disease as a risk factor for
cardiovascular disease: A systematic review and meta-analysis. Journal of
Cardiology, 72(2), 141-149.
 O'Hare, A. M., et al. (2004). Peripheral arterial disease in chronic kidney
disease: A systematic review. Journal of the American Society of
Nephrology, 15(11), 2981-2992
 Ouma J et al. (2017). Prevalence of chronic kidney disease in western
Kenya. BMC Nephrology, 18(1), 1-9.
 Pfeffer MA et al. Family history a s a predictor of cardiovascular disease: A
systematic review and meta-analysis. Ann Intern Med 2015;162(10):741-
750.
 U.S. Department of Health and Human Services Centers for Disease Control
and Prevention Office on Smoking & Health. How Tobacco Smoke Causes
Disease: The Biology and Behavioral Basis for Tobacco Attributable
Disease
 Vihiga County Government. (2019). Vihiga County Health Profile.
 Zoccali C Et al. Cardiovascular outcomes in patients with chronic kidney
dispease: A systematic review. J Cardiol Cardiovasc Ther 2017;32(2):147-
157.

24