Association of Persistent Abnormal Echocardiographic Parameters with All-Cause Mortality in Hemodialysis Patients: A Cohort Study

Introduction: Echocardiography is commonly used to assess cardiac function and volume load in patients undergoing hemodialysis; however, its association with all-cause mortality remains controversial. Most studies have focused on baseline data, leaving the impact of longitudinal changes in echocardiographic parameters unexamined. This study aimed to analyze the effects of baseline and follow-up echocardiographic parameters on all-cause mortality in a large cohort. Methods: We assessed 1,586 patients who underwent hemodialysis at the First Affiliated Hospital, College of Medicine, Zhejiang University. Associations between echocardiographic parameters and all-cause mortality were examined using restricted cubic splines and Cox proportional hazards models. Both baseline and time-averaged (TA) echocardiographic parameters were included in the analysis. Results: The baseline and TA values of echocardiographic parameters showed a strong linear correlation. Higher baseline left ventricular ejection fraction (LVEF) was associated with a lower risk of all-cause mortality (hazard ratio [HR], 0.976; 95% confidence interval [CI], 0.964–0.989; P < 0.001), and the same trend was observed for TA-LVEF. An elevated cardiothoracic ratio (CTR) was identified as a risk factor for all-cause mortality (HR, 18.769; 95% CI, 2.476–142.298; P = 0.005), and higher TA-CTR was also associated with an increased risk of all-cause mortality. A U-shaped association was found between left ventricular end-diastolic dimension (LVEDD) and all-cause mortality. Conclusion: Lower LVEF and higher CTR were associated with all-cause mortality in patients undergoing hemodialysis. The association between LVEDD and all-cause mortality followed a U-shaped curve.