Diastolic function is a strong predictor of mortality in patients with chronic kidney disease

Abstract

BackgroundCardiovascular disease is a major cause of death in patients with stage 4–5 Chronic Kidney disease (CKD, eGFR < 30). There are only limited data on the risk factors predicting these complications in CKD patients. Our aim was to determine the role of clinical and echocardiographic parameters in predicting mortality and cardiovascular complications in CKD patients.MethodsWe conducted a prospective observational cohort study of 153 CKD patients between 2007 and 2009. All patients underwent echocardiography at baseline and were followed for a mean of 2.6 years using regular clinic visits and review of files and hospital presentations to record the incidence of cardiovascular events and death.ResultsOf 153 patients enrolled, 57 (37%) were on dialysis and 45 (78%) of these patients were on haemodialysis. An enlarged LV was present in 32% of patients and in 22% the LVEF was below 55%. LV mass index was increased in 75% of patients. Some degree of diastolic dysfunction was present in 85% of patients and 35% had grade 2 or higher diastolic dysfunction. During follow up 41 patients (27%) died, 15 (39%) from cardiovascular causes. Mortality was 24.0% in the non-dialysis patients versus 31.6% in patients on dialysis (p=ns). On multivariate analysis age >75 years, previous history of MI, diastolic dysfunction and detectable serum troponin T were significant independent predictor of mortality (P < 0.01).ConclusionPatients with stage 4–5 CKD had a mortality rate of 27% over a mean follow up of 2.6 years. Age >75 years, history of MI, diastolic dysfunction and troponin T were independent predictors of mortality.

Cardiac status in patients of chronic kidney disease: an assessment by non-invasive tools

“…This was comparable to observations in the study conducted by Meyeon P et al 30 , who documented an increase in Left Ventricular Mass with increase in severity of the disease in CKD patients. The present study results are also comparable to study by Farshid A et al 18 …”

Echocardiographic Assessment of Cardiac Structural and Functional Abnormalities in Patients With End-Stage Renal Disease Receiving Chronic Hemodialysis

“…Farshid et al showed that some degree of diastolic dysfunction was present in 86% of patients on HD with a mean age of 58.7±15.0 years, and 35% had grade ≥2 diastolic dysfunction, which was a powerful independent predictor of mortality. 18 In the present study, almost all patients (i.e., those with mean age, 67.9±10.6 years) had some degree of abnormal LV filling or AF.…”

Galectin-3 als neuer Biomarker diastolischer Funktionsstörung bei Hämodialysepatienten

“…Hemodialysis patients have common comorbidities (e.g., age, hypertension, diabetes mellitus, LVH, coronary artery disease, and infiltrative cardiomyopathy) often associated with the development of myocardial fibrosis and decreased ventricular compliance, which are physiopathological landmarks of diastolic heart failure (DHF) [7]. Left ventricular diastolic dysfunction (LVDD), an early stage of DHF, is a strong predictor of cardiovascular mortality and morbidity in the general population and also in patients with chronic kidney disease [8][9][10][11]. Hence, LVDD in hemodialysis patients should be promptly identified and treated so as to improvemorbidity and mortality [7].…”