title: Diastolic function is a strong predictor of mortality in patients with chronic kidney disease.
abstract: BACKGROUND
  Cardiovascular disease is a major cause of death in patients with stage 4-5 Chronic Kidney disease (CKD, eGFR < 30). There are only limited data on the risk factors predicting these complications in CKD patients. Our aim was to determine the role of clinical and echocardiographic parameters in predicting mortality and cardiovascular complications in CKD patients.
  
  
  METHODS
  We conducted a prospective observational cohort study of 153 CKD patients between 2007 and 2009. All patients underwent echocardiography at baseline and were followed for a mean of 2.6 years using regular clinic visits and review of files and hospital presentations to record the incidence of cardiovascular events and death.
  
  
  RESULTS
  Of 153 patients enrolled, 57 (37%) were on dialysis and 45 (78%) of these patients were on haemodialysis. An enlarged LV was present in 32% of patients and in 22% the LVEF was below 55%. LV mass index was increased in 75% of patients. Some degree of diastolic dysfunction was present in 85% of patients and 35% had grade 2 or higher diastolic dysfunction. During follow up 41 patients (27%) died, 15 (39%) from cardiovascular causes. Mortality was 24.0% in the non-dialysis patients versus 31.6% in patients on dialysis (p=ns). On multivariate analysis age >75 years, previous history of MI, diastolic dysfunction and detectable serum troponin T were significant independent predictor of mortality (P < 0.01).
  
  
  CONCLUSIONS
  Patients with stage 4-5 CKD had a mortality rate of 27% over a mean follow up of 2.6 years. Age >75 years, history of MI, diastolic dysfunction and troponin T were independent predictors of mortality.
authors.affiliation: Cardiology Unit, The Canberra Hospital, PO Box 11, Woden, ACT 2605, Australia. afarshid@tpg.com.au.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Farshid
authors.forename: Rajeev
authors.initials: R
authors.lastname: Pathak
authors.forename: Bruce
authors.initials: B
authors.lastname: Shadbolt
authors.forename: Leonard
authors.initials: L
authors.lastname: Arnolda
authors.forename: Girish
authors.initials: G
authors.lastname: Talaulikar
mesh_terms: D000368:Aged; D020958:Australian Capital Territory / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000401:mortality*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016019:Survival Analysis; D015996:Survival Rate; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*