title: Echocardiographic parameters as cardiovascular event predictors in hemodialysis patients.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established in literature.
  
  
  OBJECTIVE
  To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis.
  
  
  METHODS
  Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them.
  
  
  RESULTS
  Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD), ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005) and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042) were independent risk factors for cardiovascular events.
  
  
  CONCLUSIONS
  Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.
authors: Universidade Federal do Maranhão, São Luís, MA, Brasil. thayse_siqueira@hotmail.com
authors: Thayse Mayara Aragão
authors: TM
authors: Siqueira
authors: Pedro Antônio Muniz
authors: PA
authors: Ferreira
authors: Francisco das Chagas
authors: Fd
authors: Monteiro Júnior
authors: Natalino
authors: N
authors: Salgado Filho
authors: Adalgisa de Souza Paiva
authors: Ade S
authors: Ferreira
authors: Eugênio Dos
authors: ED
authors: Santos Neto
authors: Francival Leite de
authors: FL
authors: Souza
authors: Paulo de Tarso
authors: Pde T
authors: Cardoso
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology