title: Association of echocardiographic abnormalities with mortality in men with non-dialysis-dependent chronic kidney disease.
abstract: BACKGROUND
  The interrelationship of left ventricular hypertrophy (LVH) with ejection fraction (EF) and their impact on mortality in non-dialysis-dependent chronic kidney disease (NDD-CKD) is unclear.
  
  
  METHODS
  We examined the associations of EF and LVH with all-cause mortality in a historic cohort of 650 male US veterans with moderate-to-advanced NDD-CKD. EF and LVH were examined both separately and after categorizing patients according to their concomitant EF and presence/absence of LVH. Associations with mortality were examined in Cox models with adjustments for demographics, blood pressure, comorbidities, smoking status, medication use and biochemical characteristics.
  
  
  RESULTS
  EF <30 and 30-50% were associated with higher all-cause mortality compared to EF >50% even after multivariable adjustments [multivariable adjusted hazard ratio, 95% confidence interval (CI): 2.83 (1.86-4.30) and 1.38 (1.06-1.78), P < 0.001 for linear trend]. LVH in itself was not associated with mortality [multivariable adjusted hazard ratio, 95% CI: 0.83 (0.66-1.05), P = 0.12], but the presence of LVH combined with an EF <50% was associated with the highest mortality [multivariable adjusted hazard ratios, 95% CI in patients with EF >50% + LVH, EF ≤ 50%-LVH and EF ≤ 50% + LVH, compared to EF >50%-LVH: 0.84 (0.63-1.13), 1.36 (1.00-1.83) and 1.62 (1.07-2.46)].
  
  
  CONCLUSIONS
  Low EF is associated with higher mortality in patients with NDD-CKD. In the presence of a low EF, LVH is also associated with higher mortality. Clinical trials are needed to determine if interventions targeting patients with low EF and LVH can lower mortality in NDD-CKD.
authors: Department of Medicine, Carilion Clinic, Roanoke, VA, USA.
authors: Jason
authors: J
authors: Payne
authors: Smriti
authors: S
authors: Sharma
authors: Dexter
authors: D
authors: De Leon
authors: Jun L
authors: JL
authors: Lu
authors: Fregenet
authors: F
authors: Alemu
authors: Rasheed A
authors: RA
authors: Balogun
authors: Sandra M
authors: SM
authors: Malakauskas
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
authors: Csaba P
authors: CP
authors: Kovesdy
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