Predictors of congestive heart failure in patients on maintenance hemodialysis.
BACKGROUND
Cardiovascular disease is a major cause of death in patients on maintenance hemodialysis (HD). Predictors of congestive heart failure (CHF) events in patients on HD were investigated, focusing on left ventricular (LV) function.


RESULTS
One hundred consecutive patients on HD were followed for at least 5 years after index examination performed 1 day after the last HD session. Tests included M-mode and Doppler echocardiography and plasma brain natriuretic peptide (BNP) and hemoglobin (Hb) concentration measurements. Patients with atrial fibrillation or poor echocardiographic images were excluded. Confounding factors included diabetes mellitus (DM), hypertension, age, HD duration, LV fractional shortening, E/A of transmitral flow velocity pattern, Tei index, LV mass index (LVMI), BNP level, Hb, and use of antihypertensive or antiarrhythmic drugs. Six CHF events occurred during 1,703+/-565 days. DM and Hb <10 g/dl were identified as independent predictors of CHF events in a stepwise Cox regression model after DM, LVMI, BNP, and Hb <10 g/dl were selected in the univariate analysis. The hazard ratio (confidence interval) was 10.96 (1.49-80.44) for DM, and 23.00 (2.41-219.76) for Hb <10 g/dl. The estimated hazard across time was constant (T_COV*DM; p=0.726, T_COV*Hb <10 g/dl; p=0.681) by time-dependent covariates analysis.


CONCLUSIONS
In patients on maintenance HD, DM and anemia (Hb <10 g/dl), but not echo-derived cardiac function, predicted CHF events.
Ito
Shigenori
S
Division of Cardiology, Nagoya City Moriyama Municipal Hospital, Nagoya, Japan. shigeito5@hotmail.com
Murai
Sumiko
S
Sugiura
Masato
M
Yoshida
Takayuki
T
Fukutomi
Tatsuya
T
D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000150:complications / Q000628:therapy; D048909:Diabetes Complications / Q000097:blood / Q000209:etiology* / Q000628:therapy; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects; D016277:Ventricular Function, Left
D006454:Hemoglobins; D020097:Natriuretic Peptide, Brain