title: Do echocardiographic parameters predict mortality in patients with end-stage renal disease?
abstract: BACKGROUND
  Left ventricular function predicts cardiovascular mortality both in the general population and those with end-stage renal disease. Echocardiography is commonly undertaken as a screening test before kidney transplantation; however, there are little data on its predictive power.
  
  
  METHODS
  This was a retrospective review of patients assessed for renal transplantation from 2000 to 2009. A survival analysis using demographic and echocardiographic variables was undertaken using the Cox proportional hazards regression model.
  
  
  RESULTS
  Of 862 patients assessed for transplantation, 739 had an echocardiogram and 217 of 739 (29%) died during a mean follow-up of 4.2 years. In a multivariate survival analysis, increased age (P<0.0001), diabetes (P<0.0001), transplant listing status (P<0.0001), severely impaired left ventricular function (P<0.01), pulmonary hypertension and/or right ventricular dysfunction (P=0.01), and regional wall motion abnormalities (P<0.01) were associated with all-cause mortality. Combined in a score where one point was given for the presence of each of the parameters above, these factors were strongly predictive of increased mortality with a hazard ratio of 3.57, 6.80, and 44.47 for the presence of one, two, or more factors, respectively, compared with the absence of any of these factors.
  
  
  CONCLUSIONS
  In patients with end-stage renal disease, multiple easily determined echocardiographic parameters, including regional wall motion abnormalities and pulmonary hypertension and/or right ventricular dysfunction, were independently associated with all-cause and cardiovascular mortality. Combining these factors in a simple score may further assist in risk stratifying patients being considered for renal transplantation.
authors.affiliation: Nephrology Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Stallworthy
authors.forename: Helen L
authors.initials: HL
authors.lastname: Pilmore
authors.forename: Mark W I
authors.initials: MW
authors.lastname: Webster
authors.forename: Karishma K
authors.initials: KK
authors.lastname: Sidhu
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Curry
authors.forename: Pieta
authors.initials: P
authors.lastname: Brown
authors.forename: Anish
authors.initials: A
authors.lastname: Scaria
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016277:Ventricular Function, Left