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2016 ; 67
(10
): 1173-1182
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Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage
Renal Disease Initiating Hemodialysis
#MMPMID26965538
Hickson LJ
; Negrotto SM
; Onuigbo M
; Scott CG
; Rule AD
; Norby SM
; Albright RC
; Casey ET
; Dillon JJ
; Pellikka PA
; Pislaru SV
; Best PJM
; Villarraga HR
; Lin G
; Williams AW
; Nkomo VT
J Am Coll Cardiol
2016[Mar]; 67
(10
): 1173-1182
PMID26965538
show ga
BACKGROUND: Cardiovascular disease among hemodialysis (HD) patients is linked to
poor outcomes. The Acute Dialysis Quality Initiative Workgroup proposed
echocardiographic (ECHO) criteria for structural heart disease (SHD) in dialysis
patients. The association of SHD with important patient outcomes is not well
defined. OBJECTIVES: This study sought to determine prevalence of ECHO-determined
SHD and its association with survival among incident HD patients. METHODS: We
analyzed patients who began chronic HD from 2001 to 2013 who underwent ECHO ?1
month prior to or ?3 months following initiation of HD (n = 654). RESULTS: Mean
patient age was 66 ± 16 years, and 60% of patients were male. ECHO findings that
met 1 or more and ?3 of the new criteria were discovered in 87% and 54% of
patients, respectively. Over a median of 2.4 years, 415 patients died: 108 (26%)
died within 6 months. Five-year mortality was 62%. Age- and sex-adjusted
structural heart disease variables associated with death were left ventricular
ejection fraction (LVEF) ?45% (hazard ratio [HR]: 1.48; confidence interval [CI]:
1.20 to 1.83) and right ventricular (RV) systolic dysfunction (HR: 1.68; CI: 1.35
to 2.07). An additive of higher death risk included LVEF ?45% and RV systolic
dysfunction rather than neither (HR: 2.04; CI: 1.57 to 2.67; p = 0.53 for test
for interaction). Following adjustment for age, sex, race, diabetic kidney
disease, and dialysis access, RV dysfunction was independently associated with
death (HR: 1.66; CI 1.34 to 2.06; p < 0.001). CONCLUSIONS: SHD was common in our
HD study population, and RV systolic dysfunction independently predicted
mortality.
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