Key result
Extreme LVEF+LVEDD levels linked to up to ~120% higher mortality in peritoneal dialysis patients.
Why the study?
End-stage renal disease is often complicated by left ventricular dysfunction, which carries a poor prognosis, but the prognostic association of combined baseline LVEF and LVEDD in peritoneal dialysis patients was not established.
Does the combination of baseline LVEF and LVEDD predict mortality in peritoneal dialysis patients?
Cohort (n=1,511)
Yes
Does the combination of baseline LVEF and LVEDD predict mortality in peritoneal dialysis patients?
The combination of LVEF and LVEDD exhibits a U-shaped association with all-cause and cardiovascular mortality in peritoneal dialysis patients, suggesting its utility as a prognostic marker.
LVEF+LVEDD may inform prognosis in peritoneal dialysis patients; leaves open whether it improves risk stratification beyond standard markers.
End-stage renal disease (ESRD) is often complicated by left ventricular dysfunction, which is associated with a poor prognosis. This study aims to investigate the association between baseline left ventricular ejection fraction (LVEF) plus left ventricular end-diastolic diameter (LVEDD) with outcomes in peritoneal dialysis (PD) patients. In this multicenter retrospective study, 1,511 incident Chinese patients on PD between 1 January 2005 and 31 December 2021 were enrolled. Restricted cubic splines (RCS) were used to explore the non-linear associations between LVEF+LVEDD and the risk of mortality. Parametric models for interval-censored survival-time data (stintreg) were used to examine the association between LVEF+LVEDD quartiles and the outcomes. During 6,451.11 person-years of follow-up [median 4.81 (IQR 3.61-6.81) years], 247 (17.8%) patients died, including 88 cardiovascular deaths. RCS showed a U-shaped association between LVEF+LVEDD and the risks of all-cause and CV mortality. According to the quartiles, the optimal range of LVEF+LVEDD associated with the lowest risk of all-cause and CV mortality was 103-107, which was set as the reference range. Both higher (≥115) and lower (<103) levels of LVEF+LVEDD were associated with increased risks of all-cause mortality (hazard ratio [HR] 2.20, 95% confidence interval [CI] 1.58-3.07; HR 1.68, 95% CI 1.19-2.36) and cardiovascular mortality (HR 2.51, 95% CI 1.33-4.75; HR 1.86, 95% CI 0.96-3.61). Low and high levels of baseline LVEF+LVEDD were associated with increased risks of all-cause and cardiovascular mortality in PD patients.
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You et al. (2025) conducted a cohort in End-stage renal disease on peritoneal dialysis (n=1,511). High LVEF+LVEDD (≥115) vs. Optimal LVEF+LVEDD (103-107) was evaluated on All-cause mortality (HR 2.20, 95% CI 1.58-3.07, p=<0.001). Both higher (≥115) and lower (<103) levels of baseline LVEF+LVEDD were associated with increased risks of all-cause mortality (HR 2.20 and HR 1.68, respectively) in peritoneal dialysis patients.
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