Key result
An increase in left ventricular ejection fraction of more than 5% over one year in stable hemodialysis patients was associated with a 1.43-fold higher risk of all-cause mortality compared to a stationary ejection fraction.
Why the study?
Information on left ventricular structural and functional changes during stable, long-term hemodialysis treatment was limited.
Cohort (n=1,034)
Yes
Hazard Ratio: 1.43 (95% CI 1.01–2.04)
Absolute Event Rate: 5.8% vs 4.21%
p-value: p=0.001
In stable hemodialysis patients, baseline heart failure with reduced ejection fraction (<50%) and paradoxical increases in ejection fraction (>5%) over time are associated with significantly increased all-cause mortality.
Should not yet alter LVEF monitoring in hemodialysis; hypothesis-generating observational association needing prospective validation.
Left ventricular (LV) structure and function anomalies are frequent during the CKD continuum and are associated with increased risk of mortality. Cross section and longitudinal ultrasound data are available for advanced CKD and transition to ESKD. Less information is available about LV changes during stable, long-term hemodialysis (HD) treatment. All stable HD patients from 9 HD centers (1034 patients, 671 males, age 58.71 ± 12.94 years) have been enrolled in January 2015. The cohort was followed-up for 4 years, kidney transplantation or death. Yearly, two-dimensional and M-mode continuous and Pulse Doppler echocardiography were performed. During the follow-up, the prevalence of cardiovascular comorbidities significantly increased (p < 0.0001), coronary artery disease (CAD) from 73.5 to 88.8%, peripheral artery disease (PAD) from 29 to 40.9%, cerebral vascular disease (CVD) from 20.4 to 30.8%, heart valves calcification (VC) from 65.6 to 89.3% and left ventricular hypertrophy (LVH) from 67.6 to 76.5%. The mortality risk increased with the presence of CAD (1.59-fold), PAD (1.61-fold), CVD (1.59-fold), and VC (1.77-fold). Mortality risk was increased in those with LVEF < 50% (LVEF 40-49% 1.5-fold and LVEF < 40% 2.3 fold). Among the survivors of the first year, LVEF varied (> 5% decrease, > 5% increase and ± 5% variations). More than 5% increase of LVEF was associated with higher mortality risk (crude 1.5-fold, adjusted 1.43-fold) compared to stationary EF (p = 0.001). Cardiovascular disease progresses during stable long-term HD therapy and increases mortality risk. HF becomes highly prevalent but only HF with decreased LVEF < 50% is associated with increased risk of mortality.
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Chișavu et al. (2021) conducted a cohort in End-stage renal disease on stable hemodialysis (n=1,034). >5% increase in left ventricular ejection fraction vs. Stationary ejection fraction (±5% variation) was evaluated on All-cause mortality (HR 1.43, 95% CI 1.01-2.04, p=0.001). An increase in left ventricular ejection fraction of more than 5% over one year in stable hemodialysis patients was associated with a 1.43-fold higher risk of all-cause mortality compared to a stationary ejection fraction.
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