title: Left ventricular end-diastolic diameter is an independent predictor of mortality in hemodialysis patients.
abstract: Left ventricular (LV) function is impaired in most hemodialysis (HD) patients. We conducted an observational cohort study to investigate whether LV end-diastolic diameter (LVDd) could predict all-cause mortality in a cohort of 166 HD patients. The LVDd values (5.06 ± 0.64 cm) of the non-survivor group were significantly greater than in the survivor group (4.78 ± 0.71 cm). The area under the receiver operating characteristic curve for an LVDd cut-off value of 5.01 cm was 0.6145 (P = 0.0234). The sensitivity and specificity of the LVDd threshold of 5.01 cm were 75.7% and 50.4%, respectively. The 4-year survival rate was significantly lower in the group with LVDd ≥ 5.01 cm than in the group with LVDd < 5.01 cm (log-rank test, P = 0.0047). Multivariate analysis with adjustments for clinical and echocardiographic parameters showed that increased LVDd was an independent predictor of all-cause mortality (hazard ratio 2.363, 95% CI 1.320-4.228, P = 0.0013). The results of the present study showed that increased LVDd predicts the all-cause mortality of chronic HD patients better than other echocardiographic parameters. Our findings suggest that LVDd measurements may be helpful for risk stratification and providing therapeutic direction for the management of HD patients.
authors.affiliation: Department of Medicine, Kidney Center             Department of Medicine, Medical Center East, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Inoue
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ogawa
authors.forename: Yuko
authors.initials: Y
authors.lastname: Iwabuchi
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Otsuka
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology