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. 2026 Jan 9.
doi: 10.1007/s10554-025-03601-9. Online ahead of print.

Diastolic dysfunction and the risk of end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease

Mathilde Zeuthen Pedersen  1   2 , Kristoffer Grundtvig Skaarup  1   2 , Nino Emanuel Landler  1   2 , Flemming Javier Olsen  3   4 , Jacob Christensen  1   2 , Niklas Dyrby Johansen  1   2 , Mats Christian Højbjerg Lassen  1   2 , Christina Christoffersen  5   6 , Ellen Linnea Freese Ballegaard  7   8 , Ida Maria Hjelm Sørensen  9 , Sasha Saurbrey Bjergfelt  9   5 , Susanne Bro  9 , Bo Feldt-Rasmussen  9   7 , Ditte Hansen  10   5 , Tor Biering-Sørensen  1   2
Affiliations

Diastolic dysfunction and the risk of end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease

Mathilde Zeuthen Pedersen et al. Int J Cardiovasc Imaging. .

Abstract

Purpose: Left ventricular diastolic dysfunction (LVDD) is common in chronic kidney disease (CKD) and is suggested to be linked to worse renal prognosis. We investigated the associations between both the ratio of early mitral inflow velocity to early diastolic tissue velocity (E/e') and LVDD grades with the risk of end-stage kidney disease (ESKD).

Methods: This prospective cohort study included individuals with non-dialysis-dependent CKD from the nephrology outpatient clinics at Rigshospitalet and Herlev-Gentofte hospital, Copenhagen. All participants underwent a thorough, protocolized echocardiographic examination. The outcome was time to ESKD (defined as dialysis treatment or kidney transplantation).

Results: A total of 731 participants were included. Mean age was 57 ± 13 years and 39% were female. During a median follow-up of 3.8 years (IQR: 3.3;4.5), 102 individuals reached ESKD. In multivariable Cox regression models, both increasing continuous E/e' (HR = 1.09 [95%CI:1.03;1.15], P = 0.004, per 1 unit increase) and E/e' > 14 (HR = 3.44 [95%CI:1.44;8.26], P = 0.005) (reference E/e' < 8) were associated with ESKD, while E/e' 8-14 was not. Compared with no or indeterminate LVDD, LVDD grades 2 or 3 were associated with ESKD (HR = 2.92 [95% CI:1.44;5.94], P = 0.003), while LVDD grade 1 was not. E/e' > 14 and LVDD grade 2 or 3 demonstrated similar predictive accuracy with excellent specificity and negative predictive values, but poor positive predictive values and sensitivity.

Conclusion: Prominent LVDD assessed by E/e' and LVDD grades was independently associated with worse renal prognosis and had similar predictive accuracy in patients with non-dialysis dependent CKD.

Keywords: Chronic cardiovascular-kidney disorder; Chronic kidney disease; Diastolic dysfunction; Echocardiography; Kidney failure.

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Conflict of interest statement

Declarations. Competing interests: KGS reports: Advisory Board: Sanofi Pasteur.TBS reports: Steering Committee member of the Amgen financed GALACTIC-HF trial. Chief investigator and steering committee chair of the Sanofi Pasteur financed “NUDGE-FLU” trial. Chief investigator and steering committee chair of the Sanofi Pasteur financed “DANFLU-1” trial. Chief investigator and steering committee chair of the Sanofi Pasteur financed “DANFLU-2” trial. Steering Committee member of “LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific’s Investigational ICM System” trial. Adviso-ry Board: Sanofi Pasteur, Amgen and GSK. Speaker Honorarium: Novartis, Sanofi Pasteur and GSK. Research grants: GE Healthcare and Sanofi Pasteur. The remaining authors have nothing to disclose.

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