Prognostic value of dobutamine stress echocardiography in patients with chronic kidney disease

Background Although dobutamine stress echocardiography (DSE) is cited in clinical guidelines for the evaluation of patients with chronic kidney disease (CKD), there are limited data regarding its prognostic utility in this setting. The current study assesses the prognostic value of DSE in patients with CKD. Methods Four hundred eighty-five patients with CKD (on renal dialysis or with creatinine > 3 mg/mL) who had DSE were followed for 2.3 +/- 1.8 years. Results One hundred eighty-eight (39%) patients died during follow-up. Patients with extensive ischemia (affecting > 25% of myocardial segments) had a 1- and 3-year survival rate of 77% and 48%, respectively, compared with 83% and 52% in those with lesser degrees (<= 25% segments affected) of ischemia and with 88% and 70% in those with a normal DSE. In multivariate analyses, the percentage of ischemic segments on DSE was an independent predictor of all-cause mortality (hazard ratio, 1.40 per 25% increase; 95% Cl, 1.16-1.68; P =.001). Inclusion of DSE data improved the predictive value of the best clinical model (chi(2), 83.6-97.4; P =.003). Conclusion In patients with CKD, the percentage of ischemic segments during DSE is an independent predictor of mortality and provides prognostic information that is incremental to clinical data.