Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Oct;5(10):1793-8.
doi: 10.2215/CJN.00050110. Epub 2010 Jul 1.

Prognostic value of reduced left ventricular ejection fraction at start of hemodialysis therapy on cardiovascular and all-cause mortality in end-stage renal disease patients

Shigeki Yamada  1 , Hideki Ishii, Hiroshi Takahashi, Toru Aoyama, Yasuhiro Morita, Hirotake Kasuga, Keiko Kimura, Yutaka Ito, Ryo Takahashi, Takanobu Toriyama, Yoshinari Yasuda, Mutsuharu Hayashi, Hideki Kamiya, Yukio Yuzawa, Shoichi Maruyama, Seiichi Matsuo, Tatsuaki Matsubara, Toyoaki Murohara
Affiliations

Prognostic value of reduced left ventricular ejection fraction at start of hemodialysis therapy on cardiovascular and all-cause mortality in end-stage renal disease patients

Shigeki Yamada et al. Clin J Am Soc Nephrol. 2010 Oct.

Abstract

Background and objectives: Cardiac failure is directly affected by left ventricular (LV) dysfunction, and particularly LV systolic dysfunction is strongly associated with survival in ESRD patients. The aim of this study was to determine the prognostic value of reduced LV ejection fraction (LVEF) measured at the time of initiation of hemodialysis (HD) in incident HD patients.

Design, setting, participants, & measurements: 1254 consecutive ESRD patients who electively started HD therapy were screened by echocardiography within 1 month after its inception. They were divided into five groups according to LVEF levels with a decrease of 0.1 each and were followed up for up to 7 years. Survival was examined with the Kaplan-Meier method and compared using the log-rank test.

Results: Among the 1254 patients, LVEF levels ≥0.6, 0.5 to 0.6, 0.4 to 0.5, 0.3 to 0.4, and <0.3 were seen in 842 (67.1%), 247 (19.7%), 107 (8.5%), 41 (3.3%), and 17 (1.4%) patients, respectively. On Kaplan-Meier analysis, 7-year event-free rates from cardiovascular death were 84.2, 83.7, 73.6, 59.4, and 30.9% in order of groups with decreasing LVEF of 0.1 each, respectively. Seven-year event-free rates from all-cause death were 69.2, 61.7, 57.1, 45.9, and 23.1% in the respective groups. Even after adjustment for other risk factors, decreasing LVEF was a strong independent predictor for cardiovascular death.

Conclusions: Reduced LVEF on starting HD therapy could stratify risk of cardiovascular and all-cause mortality in ESRD patients. Screening by echocardiography at start of HD therapy might be recommended to predict prognosis in patients with ESRD.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Kaplan-Meier estimates: Event-free survival from cardiovascular death.
Figure 2.
Figure 2.
Kaplan-Meier estimates: Event-free survival from all-cause death.
See this image and copyright information in PMC

References

    1. Lindner A, Charra B, Sherrard DJ, Scribner BH: Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 290: 697–701, 1974 - PubMed
    1. Goldsmith DJA, Covic A: Coronary artery disease in uremia: Etiology, diagnosis, and therapy. Kidney Int 60: 2059–2078, 2001 - PubMed
    1. Herzog CA, Ma JZ, Collins AJ: Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 339: 799–805, 1998 - PubMed
    1. Parfrey PS, Foley RN: The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 10: 1606–1615, 1999 - PubMed
    1. Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV, Teehan BP, Levey AS: The Hemodialysis (HEMO) Study. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int 58: 353–362, 2000 - PubMed

MeSH terms