Key result
In nondialysis CKD, LVEF <50% is linked to ~117% higher cardiovascular event risk versus >60%.
Why the study?
Identifying nondialysis chronic kidney disease patients at higher risk of end-stage kidney disease or adverse cardiovascular events is essential to optimize management, but the role of LVEF in predicting these outcomes needed evaluation.
Cohort (n=580)
Yes
Effect estimate: HR 2.17 (95% CI 1.27-3.72)
In hypertensive patients with nondialysis CKD, lower LVEF is an independent predictor of adverse cardiovascular and renal outcomes.
Supports LVEF-based risk stratification in hypertensive nondialysis CKD; leaves open whether LVEF-targeted interventions improve outcomes.
OBJECTIVES: Identification of nondialysis chronic kidney disease (CKD) patients at a higher risk of end-stage kidney disease (ESKD) or adverse cardiovascular events is the first essential step to optimize management. We evaluated the role of left ventricular ejection fraction (LVEF) in predicting cardiac and renal outcome in CKD. METHODS: We prospectively studied 580 consecutive patients with nondialysis CKD followed in two Italian renal clinics in order to evaluate the association between LVEF as either continuous variable or categories (>60, 50-60 and <50%) and adjusted risks (hazard ratio, 95% confidence interval) of either cardiovascular (composite of fatal and nonfatal cardiovascular events) or renal events (composite of ESKD and all-cause death before ESKD). RESULTS: The mean age of participants was 65.0 ± 13.5 years, 62% men, eGFR 41.3 ± 21.1 ml/min/1.73 m 2 , LVEF 60.6 ± 8.1% and left ventricular mass index (LVMI) 59.3 ± 17.6 g/m 2.7 . LVEF more than 60%, 50-60% and <50% was recorded in 274, 234 and 72 patients, respectively. Patients with LVEF less than 50% were predominantly men with more frequent history of cardiovascular disease and lower eGFR; in addition, they had higher 24 h, daytime and nighttime blood pressure. During the follow-up (median 5.0 years, IQR 4.9-7.1), cardiovascular and renal endpoints were registered in 113 and 228 patients, respectively. LVEF as a continuous variable was inversely associated with the adjusted risk of either cardiovascular (0.97, 0.95-0.99) or renal endpoint (0.98, 0.97-0.995). In comparison with patients with LVEF more than 60%, the risk of cardiovascular events was increased in patients with LVEF 50-60% (1.64, 1.06-2.53) and less than 50% (2.17, 1.27-3.72). The same occurred for renal endpoint (1.68, 1.24-2.27 and 1.73, 1.15-2.59 for LVEF 50-60% and <50%, respectively). CONCLUSION: In CKD patients, lower LVEF is associated with worse cardiorenal prognosis, independently from LVMI.
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Paoletti et al. (2025) conducted a cohort in hypertensive patients with nondialysis chronic kidney disease (n=580). Left ventricular ejection fraction (LVEF) <50% vs. LVEF >60% was evaluated on composite of fatal and nonfatal cardiovascular events (HR 2.17, 95% CI 1.27-3.72). In nondialysis CKD patients, LVEF <50% vs >60% was associated with increased risks of cardiovascular events (HR 2.17; 95% CI 1.27-3.72) and renal events (HR 1.73; 95% CI 1.15-2.59).
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