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. 2012 Feb;27(2):694-700.
doi: 10.1093/ndt/gfr282. Epub 2011 May 25.

Association of echocardiographic abnormalities with mortality in men with non-dialysis-dependent chronic kidney disease

Jason Payne  1 , Smriti Sharma, Dexter De Leon, Jun L Lu, Fregenet Alemu, Rasheed A Balogun, Sandra M Malakauskas, Kamyar Kalantar-Zadeh, Csaba P Kovesdy
Affiliations

Association of echocardiographic abnormalities with mortality in men with non-dialysis-dependent chronic kidney disease

Jason Payne et al. Nephrol Dial Transplant. 2012 Feb.

Abstract

Background: The interrelationship of left ventricular hypertrophy (LVH) with ejection fraction (EF) and their impact on mortality in non-dialysis-dependent chronic kidney disease (NDD-CKD) is unclear.

Methods: We examined the associations of EF and LVH with all-cause mortality in a historic cohort of 650 male US veterans with moderate-to-advanced NDD-CKD. EF and LVH were examined both separately and after categorizing patients according to their concomitant EF and presence/absence of LVH. Associations with mortality were examined in Cox models with adjustments for demographics, blood pressure, comorbidities, smoking status, medication use and biochemical characteristics.

Results: EF <30 and 30-50% were associated with higher all-cause mortality compared to EF >50% even after multivariable adjustments [multivariable adjusted hazard ratio, 95% confidence interval (CI): 2.83 (1.86-4.30) and 1.38 (1.06-1.78), P < 0.001 for linear trend]. LVH in itself was not associated with mortality [multivariable adjusted hazard ratio, 95% CI: 0.83 (0.66-1.05), P = 0.12], but the presence of LVH combined with an EF <50% was associated with the highest mortality [multivariable adjusted hazard ratios, 95% CI in patients with EF >50% + LVH, EF ≤ 50%-LVH and EF ≤ 50% + LVH, compared to EF >50%-LVH: 0.84 (0.63-1.13), 1.36 (1.00-1.83) and 1.62 (1.07-2.46)].

Conclusions: Low EF is associated with higher mortality in patients with NDD-CKD. In the presence of a low EF, LVH is also associated with higher mortality. Clinical trials are needed to determine if interventions targeting patients with low EF and LVH can lower mortality in NDD-CKD.

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Figures

Fig. 1.
Fig. 1.
Kaplan–Meier survival curves of patients categorized according to their EF level. Comparisons were made by the log rank test for equality of survivor function.
Fig. 2.
Fig. 2.
Kaplan–Meier survival curves of patients categorized according to the presence or absence of LVH. Comparisons were made by the log rank test for equality of survivor function.
See this image and copyright information in PMC

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