title: Prognostic value of reduced left ventricular ejection fraction at start of hemodialysis therapy on cardiovascular and all-cause mortality in end-stage renal disease patients.
abstract: OBJECTIVE
  Cardiac failure is directly affected by left ventricular (LV) dysfunction, and particularly LV systolic dysfunction is strongly associated with survival in ESRD patients. The aim of this study was to determine the prognostic value of reduced LV ejection fraction (LVEF) measured at the time of initiation of hemodialysis (HD) in incident HD patients.
  
  
  METHODS
  1254 consecutive ESRD patients who electively started HD therapy were screened by echocardiography within 1 month after its inception. They were divided into five groups according to LVEF levels with a decrease of 0.1 each and were followed up for up to 7 years. Survival was examined with the Kaplan-Meier method and compared using the log-rank test.
  
  
  RESULTS
  Among the 1254 patients, LVEF levels ≥0.6, 0.5 to 0.6, 0.4 to 0.5, 0.3 to 0.4, and <0.3 were seen in 842 (67.1%), 247 (19.7%), 107 (8.5%), 41 (3.3%), and 17 (1.4%) patients, respectively. On Kaplan-Meier analysis, 7-year event-free rates from cardiovascular death were 84.2, 83.7, 73.6, 59.4, and 30.9% in order of groups with decreasing LVEF of 0.1 each, respectively. Seven-year event-free rates from all-cause death were 69.2, 61.7, 57.1, 45.9, and 23.1% in the respective groups. Even after adjustment for other risk factors, decreasing LVEF was a strong independent predictor for cardiovascular death.
  
  
  CONCLUSIONS
  Reduced LVEF on starting HD therapy could stratify risk of cardiovascular and all-cause mortality in ESRD patients. Screening by echocardiography at start of HD therapy might be recommended to predict prognosis in patients with ESRD.
authors.affiliation: Nagoya Kyoritsu Hospital, Nagoya, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yamada
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Morita
authors.forename: Hirotake
authors.initials: H
authors.lastname: Kasuga
authors.forename: Keiko
authors.initials: K
authors.lastname: Kimura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ito
authors.forename: Ryo
authors.initials: R
authors.lastname: Takahashi
authors.forename: Takanobu
authors.initials: T
authors.lastname: Toriyama
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Mutsuharu
authors.initials: M
authors.lastname: Hayashi
authors.forename: Hideki
authors.initials: H
authors.lastname: Kamiya
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.forename: Shoichi
authors.initials: S
authors.lastname: Maruyama
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D016277:Ventricular Function, Left