January 10, 2026The International Journal of Cardiovascular Imaging0 citationsOpen Access

Diastolic dysfunction and the risk of end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic kidney disease (n=731). Primary outcome: Time to end-stage kidney disease (ESKD) defined as dialysis treatment or kidney transplantation (HR 1.09, 95% CI 1.03-1.15, p=0.004).

MPMathilde Zeuthen PedersenUniversity of Copenhagen KSKristoffer Grundtvig SkaarupCardiac Imaging NLNino Emanuel LandlerUniversity of Copenhagen

Key Result

In patients with non-dialysis-dependent chronic kidney disease, left ventricular diastolic dysfunction assessed by E/e’ is significantly associated with an increased risk of end-stage kidney disease.

Key Points

To investigate the relationship between left ventricular diastolic dysfunction and the risk of end-stage kidney disease in patients with non-dialysis-dependent chronic kidney disease.
Prospective cohort study design
Participants included non-dialysis-dependent chronic kidney disease patients from two outpatient clinics in Copenhagen
Echocardiographic examinations conducted to assess diastolic function
Follow-up to determine time to end-stage kidney disease via dialysis or kidney transplantation
731 participants were analyzed with a median follow-up of 3.8 years
102 individuals developed end-stage kidney disease during the follow-up period
Increased E/e' ratio was associated with higher risk of end-stage kidney disease (HR = 1.09)
LVDD grades 2 or 3 significantly linked to end-stage kidney disease (HR = 2.92)
Both E/e' > 14 and LVDD grades 2 or 3 showed similar predictive accuracy for end-stage kidney disease

Study Design

Type

Cohort (n=731)

Multicenter

Yes

Structured PICO

Does prominent left ventricular diastolic dysfunction predict the risk of end-stage kidney disease in patients with non-dialysis-dependent chronic kidney disease?

Population

731 individuals aged 30 to 75 years with non-dialysis-dependent chronic kidney disease (eGFR stages G1-G5 pre-dialysis), mean age 57, 60.7% male, from two centers in Denmark. Key exclusions: previous kidney transplantation, pregnancy, intellectual disability, dementia or psychosis, active malignancy.

Intervention

Presence of prominent left ventricular diastolic dysfunction (LVDD) assessed by echocardiography, defined as E/e' > 14 or LVDD grade 2 or 3.

Comparator

Normal or indeterminate diastolic function, defined as E/e' < 8 or no/indeterminate LVDD.

Outcome

Time to end-stage kidney disease (ESKD), defined as a composite of dialysis treatment or kidney transplantation, at median 3.8 years follow-up.hard clinical

Prominent left ventricular diastolic dysfunction, assessed by elevated E/e' or LVDD grading, is an independent predictor of progression to end-stage kidney disease in patients with non-dialysis-dependent CKD.

Main Result

Effect estimate: HR 1.09 (95% CI 1.03-1.15)

Absolute Event Rate: 38.7% vs 11.3%

p-value: p=0.004

Limitations

Selection bias is likely present as inclusion was limited to patients with CKD in an outpatient hospital setting.
Findings may not be generalizable to non-European populations or those with different demographic characteristics.
Unable to include other renal biomarkers in models.

Abstract

Abstract Purpose Left ventricular diastolic dysfunction (LVDD) is common in chronic kidney disease (CKD) and is suggested to be linked to worse renal prognosis. We investigated the associations between both the ratio of early mitral inflow velocity to early diastolic tissue velocity (E/e’) and LVDD grades with the risk of end-stage kidney disease (ESKD). Methods This prospective cohort study included individuals with non-dialysis-dependent CKD from the nephrology outpatient clinics at Rigshospitalet and Herlev-Gentofte hospital, Copenhagen. All participants underwent a thorough, protocolized echocardiographic examination. The outcome was time to ESKD (defined as dialysis treatment or kidney transplantation). Results A total of 731 participants were included. Mean age was 57 ± 13 years and 39% were female. During a median follow-up of 3.8 years (IQR: 3.3;4.5), 102 individuals reached ESKD. In multivariable Cox regression models, both increasing continuous E/e’ (HR = 1.09 95%CI:1.03;1.15, P = 0.004, per 1 unit increase) and E/e’ > 14 (HR = 3.44 95%CI:1.44;8.26, P = 0.005) (reference E/e’ 14 and LVDD grade 2 or 3 demonstrated similar predictive accuracy with excellent specificity and negative predictive values, but poor positive predictive values and sensitivity. Conclusion Prominent LVDD assessed by E/e’ and LVDD grades was independently associated with worse renal prognosis and had similar predictive accuracy in patients with non-dialysis dependent CKD. Graphical abstract Diastolic dysfunction and the risk of ESKD among patients with non-dialysis-dependent CKD. The CPH-CKD study is a prospective cohort study of non-dialysis dependent CKD patients. All participants were systematically examined with a pre-defined protocolized echocardiography and followed for median 3.8 years- A total of 731 were included in the study sample and 102 developed ESKD. We found a significant, independent association between LVDD assessed by E/e’ and LVDD grades and worse renal prognosis in patients with non-dialysis dependent CKD. E/e’ and LVDD grading had similar predictive accuracy. Abbreviations: CKD (chronic kidney disease), ESKD (end-stage kidney disease), E/e’ (ratio of early mitral inflow velocity to early diastolic tissue velocity), LVDD (left ventricular diastolic dysfunction).

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