title: Echocardiography to predict adverse cardiac and vascular events in patients with severe chronic kidney disease (stage 4): a prospective study.
abstract: BACKGROUND
  Cardiovascular disease is the primary cause of mortality and morbidity among patients with chronic kidney disease.
  
  
  OBJECTIVE
  To investigate whether echocardiography can predict the occurrence of major cardiovascular events in patients with severe chronic kidney disease.
  
  
  METHODS
  Patients with stable stage 4 chronic kidney disease (estimated glomerular filtration rate 15-29 mL/min/1.73 m(2)) and followed in the nephrology department were included. Clinical, biological, electrocardiographic and echocardiographic data were recorded. Endpoint was defined as fatal or non-fatal cardiovascular event (acute coronary syndrome, acute heart failure, stroke, sustained ventricular arrhythmias, arterial thrombotic events and death).
  
  
  RESULTS
  We included 71 patients (46 men); mean age 72±14 years. Mean glomerular filtration rate was 21.9±4.8 mL/min/1.73 m(2). Over a mean follow-up of 258±30 days, 18 (25%) patients reached endpoint (death in 7/18). Male sex, blood urea, atrial fibrillation, Sokolow index, left atrial size, pulmonary arterial pressure, indexed left ventricular mass and protodiastolic peak velocity of transmitral Doppler flow were significantly higher whereas left ventricular ejection fraction was significantly lower in these patients. By multivariable analysis, blood urea and left ventricular ejection fraction remained predictive of major cardiovascular event with odds ratios of 1.10 (95% confidence interval 1.02-1.18) and 0.93 (95% confidence interval 0.89-0.97), respectively. The negative predictive value was 95% when left ventricular ejection fraction was>50% with blood urea<15 mmol/L.
  
  
  CONCLUSIONS
  Patients with stage 4 chronic kidney disease are at high risk of major cardiovascular events and death. Echocardiographic evaluation is effective in identifying patients at highest risk of adverse cardiac events.
authors.affiliation: Department of Cardiology and Vascular Diseases, University Hospital, Hôpital Robert-Debré, Reims, France. flesaffre@chu-reims.fr
authors.forename: François
authors.initials: F
authors.lastname: Lesaffre
authors.forename: Alain
authors.initials: A
authors.lastname: Wynckel
authors.forename: Pierre
authors.initials: P
authors.lastname: Nazeyrollas
authors.forename: Philippe
authors.initials: P
authors.lastname: Rieu
authors.forename: Damien
authors.initials: D
authors.lastname: Metz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D018608:Ultrasonography, Doppler; D014508:Urea / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D014508:Urea