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.
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.
Yamada
Shigeki
S
Nagoya Kyoritsu Hospital, Nagoya, Japan.
Ishii
Hideki
H
Takahashi
Hiroshi
H
Aoyama
Toru
T
Morita
Yasuhiro
Y
Kasuga
Hirotake
H
Kimura
Keiko
K
Ito
Yutaka
Y
Takahashi
Ryo
R
Toriyama
Takanobu
T
Yasuda
Yoshinari
Y
Hayashi
Mutsuharu
M
Kamiya
Hideki
H
Yuzawa
Yukio
Y
Maruyama
Shoichi
S
Matsuo
Seiichi
S
Matsubara
Tatsuaki
T
Murohara
Toyoaki
T
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