Exploring the relation between mortality and left ventricular structure and function in stable hemodialysis treated patients, a longitudinal multicenter cohort study

Left ventricular (LV) structure and function anomalies are frequent during the CKD continuum and are associated with increased risk of mortality. Cross section and longitudinal ultrasound data are available for advanced CKD and transition to ESKD. Less information is available about LV changes durin...

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Published in:	Scientific reports Vol. 11; no. 1; p. 12694
Main Authors:	Chisavu, Lazar A., Apostol, Adrian, Pop, Gheorghe N., Ivan, Viviana, Schiller, Oana, Bob, Flaviu, Marc, Luciana, Mihaescu, Adelina, Gadalean, Florica, Grosu, Iulia, Timar, Bogdan, Schiller, Adalbert
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 16-06-2021 Nature Publishing Group Nature Portfolio
Subjects:	692/4019 692/4022 Calcification Cardiovascular disease Cardiovascular diseases Cohort analysis Coronary artery Doppler effect Echocardiography Health risks Heart diseases Hemodialysis Humanities and Social Sciences Hypertrophy Kidney transplantation Mortality Mortality risk multidisciplinary Science Science (multidisciplinary) Structure-function relationships Vascular diseases Ventricle
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Summary:	Left ventricular (LV) structure and function anomalies are frequent during the CKD continuum and are associated with increased risk of mortality. Cross section and longitudinal ultrasound data are available for advanced CKD and transition to ESKD. Less information is available about LV changes during stable, long-term hemodialysis (HD) treatment. All stable HD patients from 9 HD centers (1034 patients, 671 males, age 58.71 ± 12.94 years) have been enrolled in January 2015. The cohort was followed-up for 4 years, kidney transplantation or death. Yearly, two-dimensional and M-mode continuous and Pulse Doppler echocardiography were performed. During the follow-up, the prevalence of cardiovascular comorbidities significantly increased (p < 0.0001), coronary artery disease (CAD) from 73.5 to 88.8%, peripheral artery disease (PAD) from 29 to 40.9%, cerebral vascular disease (CVD) from 20.4 to 30.8%, heart valves calcification (VC) from 65.6 to 89.3% and left ventricular hypertrophy (LVH) from 67.6 to 76.5%. The mortality risk increased with the presence of CAD (1.59-fold), PAD (1.61-fold), CVD (1.59-fold), and VC (1.77-fold). Mortality risk was increased in those with LVEF < 50% (LVEF 40–49% 1.5-fold and LVEF < 40% 2.3 fold). Among the survivors of the first year, LVEF varied (> 5% decrease, > 5% increase and ± 5% variations). More than 5% increase of LVEF was associated with higher mortality risk (crude 1.5-fold, adjusted 1.43-fold) compared to stationary EF (p = 0.001). Cardiovascular disease progresses during stable long-term HD therapy and increases mortality risk. HF becomes highly prevalent but only HF with decreased LVEF < 50% is associated with increased risk of mortality.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2045-2322 2045-2322
DOI:	10.1038/s41598-021-91431-9