What is the clinical evidence from this study?

Study design: Cohort. Population: End-Stage Renal Disease (ESRD) initiating hemodialysis (n=654). Intervention: Right ventricular (RV) systolic dysfunction vs. Absence of RV systolic dysfunction. Primary outcome: All-cause mortality (HR 1.66, 95% CI 1.34-2.06, p=<0.001).

What does this research mean for the field?

Right ventricular systolic dysfunction independently predicts increased mortality in patients initiating chronic hemodialysis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine the prevalence of echocardiography-defined structural heart disease criteria and evaluate its association with survival among patients initiating chronic hemodialysis.

September 2, 2026Journal of the American College of CardiologyOpen Access

Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage Renal Disease Initiating Hemodialysis

Q: What are the key findings of this study?

Right ventricular systolic dysfunction independently predicted an increased risk of all-cause mortality (HR 1.66) in patients with end-stage renal disease initiating hemodialysis.

Q: What does this research mean for the field?

Right ventricular systolic dysfunction independently predicts increased mortality in patients initiating chronic hemodialysis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine the prevalence of echocardiography-defined structural heart disease criteria and evaluate its association with survival among patients initiating chronic hemodialysis.

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Key result

RV systolic dysfunction linked to ~66% higher all-cause mortality in incident hemodialysis patients.

HR 1.66
95% CI 1.34-2.06
P<0.001
n=654

Why the study?

The association between echocardiographic criteria for structural heart disease proposed by the Acute Dialysis Quality Initiative Workgroup and patient-important outcomes was not well defined.

Does echocardiographic evidence of structural heart disease predict mortality in patients with end-stage renal disease initiating hemodialysis?

Key Points

To determine the prevalence of echocardiography-defined structural heart disease criteria and evaluate its association with survival among patients initiating chronic hemodialysis.
Analyzed 654 patients initiating chronic hemodialysis between 2001 and 2013 who underwent echocardiography within 1 month prior to or 3 months following hemodialysis initiation.
Evaluated structural heart disease criteria proposed by the Acute Dialysis Quality Initiative Workgroup across a median follow-up of 2.4 years.
Structural heart disease criteria were met by 87% (≥1 criteria) and 54% (≥3 criteria) of patients, with 415 deaths overall (108 within 6 months) and a 5-year mortality of 62%.
Age- and gender-adjusted predictors of death included left ventricular ejection fraction ≤ 45% (HR 1.48, CI 1.20-1.83) and right ventricular systolic dysfunction (HR 1.68, CI 1.35-2.07), with combined dysfunction conferring additive risk (HR 2.04, CI 1.57-2.67; p = 0.53 for interaction).
Right ventricular systolic dysfunction remained independently associated with mortality following adjustment for age, gender, race, diabetic kidney disease, and dialysis access (HR 1.66; CI 1.34-2.06; p < 0.001).

Study Design

Type

Cohort (n=654)

Multicenter

Yes

Structured PICO

Does echocardiographic evidence of structural heart disease predict mortality in patients with end-stage renal disease initiating hemodialysis?

Population

654 adults with end-stage renal disease initiating hemodialysis who underwent echocardiography around the time of initiation, followed for a median of 2.4 years.

Outcome

All-cause mortality by study end (median 2.4 years follow-up)hard clinical

Main Result

Hazard Ratio: 1.66 (95% CI 1.34–2.06)

p-value: p=<0.001

Limitations

Retrospective study design
Changes in practice patterns and guidelines over the study timeframe
Limitations of semiquantitative RV assessment
Referral for echocardiography was not systematic, leading to potential selection bias
Predominantly white population may limit generalizability
Lack of data regarding dialysis-specific factors such as adequacy, bone and mineral metabolism, anemia, and hypoalbuminemia
Referral for ECHO was not systematic (potential selection bias)
Predominantly white population limiting generalizability
Lack of data regarding dialysis-specific factors (adequacy, bone and mineral metabolism, anemia, hypoalbuminemia, and AV fistula duration)

Discussion

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Implication

In patients initiating hemodialysis, structural heart disease is highly prevalent, and right ventricular systolic dysfunction is a strong, independent predictor of all-cause mortality.

Cite This Study

Hickson et al. (2016) conducted a cohort in End-Stage Renal Disease (ESRD) initiating hemodialysis (n=654). Right ventricular (RV) systolic dysfunction vs. Absence of RV systolic dysfunction was evaluated on All-cause mortality (HR 1.66, 95% CI 1.34-2.06, p=<0.001). Right ventricular systolic dysfunction independently predicted an increased risk of all-cause mortality (HR 1.66) in patients with end-stage renal disease initiating hemodialysis.

synapsesocial.com/papers/6a983e54e2c3f4e5c6dba747 https://doi.org/10.1016/j.jacc.2015.12.052

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Implication

In patients initiating hemodialysis, structural heart disease is highly prevalent, and right ventricular systolic dysfunction is a strong, independent predictor of all-cause mortality.