4309Structural or functional left sided heart disease found on echocardiographic screening is associated with a higher risk of death in patients with end stage renal disease receiving haemodialysis

Introduction Cardiovascular disease is the leading cause of death in patients with end-stage renal disease on haemodialysis. Guidelines recommend echocardiography in all incident patients on dialysis and every three years, or when considered for kidney transplantation. The prognostic value of significant valve disease or reduced systolic function detected by echocardiographic screening is however not clear. Purpose We aimed to test the hypothesis that structural heart disease in an unselected, contemporary population of patients on maintenance dialysis is associated to a higher risk of death. Methods Adult chronic haemodialysis patients in two large dialysis centers had transthoracic echocardiography performed immediately prior to dialysis and were followed prospectively. Significant structural or functional left sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%. Results Among the 247 included patients (66 [IQR 64–67] years of age, 68% male), 54 (22%) had significant structural or functional left sided heart disease. An LVEF ≤40% was observed in 31 patients (13%). Severe or moderate aortic stenosis was present in 4 (2%) and 16 (7%) patients respectively, moderate mitral regurgitation in 4 (2%) patients and mitral stenosis in one (0.4%) patient. In more than half of the patients (56%), significant structural or functional left sided heart disease was not recognized prior to the study. After 2.8 years of follow-up, all-cause mortality was 52% for patients with significant heart disease and 32% for patients without significant structural heart disease (hazard ratio [HR] 1.95 (95% CI 1.25–3.06) (Figure). On multivariable adjusted Cox proportional hazard analysis, including age, sex, ischemic heart disease, diabetes, hypertension and time on dialysis, structural heart disease was an independent predictor of mortality with a HR of 1.60 (95% CI 1.01–2.55) along with age (HR per year 1.05 [95% CI 1.03–1.07]). Kaplan-Meier estimate of survival Conclusion Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage renal failure on haemodialysis and are associated with a higher risk of death.