Journal
NEPHROLOGY
Volume 27, Issue 1, Pages 66-73Publisher
WILEY
DOI: 10.1111/nep.13960
Keywords
chronic kidney disease; echocardiography; haemodialysis; LV diastolic dysfunction; LV systolic dysfunction; mortality
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In chronic kidney disease, left ventricular diastolic dysfunction and systolic dysfunction are prevalent and independently predictive of all-cause mortality. The study found that moderate-severe LVDD and LVSD were associated with a higher probability of death and showed a progressive association between LVDD grades and mortality.
Aims Left ventricular diastolic dysfunction (LVDD) and LV systolic dysfunction (LVSD) are prevalent in CKD, but their prognostic relevance is debatable. We intent to verify whether LVDD and LVSD are independently predictive of all-cause mortality and if they have comparable or different effects on outcomes. Methods A retrospective analysis was conducted of the echocardiographic data of 1285 haemodialysis patients followed up until death or transplantation. LVDD was classified into 4 grades of severity. Endpoint was all-cause mortality. Results During a follow-up of 30 months, 419/1285 (33%) patients died, 224 (53%) due to CV events. LVDD occurred in 75% of patients, grade 1 DD was the prevalent diastolic abnormality, and pseudonormal pattern was the predominant form of moderate-severe DD. Moderate-severe LVDD (HR 1.379, CI% 1.074-1.770) and LVSD (HR 1.814, CI% 1.265-2.576) independently predicted death; a graded, progressive association was found between LVDD categories and the risk of death; and the impact of isolated severe-moderate LVDD on the risk of death was comparable to that exercised by isolated compromised LV systolic function. Conclusion Moderate-severe LVDD and LVSD were independently associated with a higher probability of death and had a similar impact on survival. A progressive association was observed between LVDD grades and mortality.
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