Cardiac remodeling and subclinical myocardial dysfunction in patients with chronic kidney disease undergoing maintenance hemodialysis: a retrospective echocardiographic study

Background: Chronic kidney disease (CKD) is a major cardiovascular burden in patients undergoing maintenance hemodialysis and has traditionally been characterized by left ventricular hypertrophy (LVH). However, growing evidence suggests that myocardial dysfunction and mineral-metabolic abnormalities may be associated with cardiac remodeling beyond hypertrophy alone. This study aimed to comprehensively evaluate structural and functional cardiac alterations and their clinical-biochemical correlates in a retrospective cohort of long-term hemodialysis patients. Methods: We retrospectively identified 120 maintenance hemodialysis patients and 60 healthy controls. Comprehensive transthoracic echocardiography, including speckle-tracking, was analyzed to assess cardiac structure, myocardial mechanics, and diastolic function. Laboratory data, including hemoglobin and phosphate, were extracted. Correlation and multivariate regression analyses were performed to evaluate associations between clinical-biochemical variables and cardiac remodeling. Results: Hemodialysis patients showed significant cardiac remodeling, characterized by increased left ventricular mass index (LVMI), left atrial enlargement, and abnormal ventricular geometry. LVH was present in 68.3% of patients, with both concentric and eccentric hypertrophic patterns. Although Teichholz-derived left ventricular ejection fraction was relatively preserved, global longitudinal strain was significantly impaired and accompanied by a high prevalence of diastolic dysfunction. Dialysis duration, systolic blood pressure, phosphate, and hemoglobin were significantly associated with increased LVMI. Conclusions: Patients receiving maintenance hemodialysis exhibited a multidimensional pattern of cardiac remodeling involving structural abnormalities, subclinical myocardial dysfunction, and mineral-metabolic dysregulation. Within the hemodialysis cohort, greater LVMI was associated with longer dialysis vintage, higher systolic blood pressure and phosphate levels, and lower hemoglobin levels. The marked impairment in myocardial strain highlights the potential value of myocardial deformation imaging for characterizing cardiac dysfunction in this population. Integrated structural, functional, and biochemical evaluation may improve early cardiovascular risk stratification in CKD-related cardiomyopathy.