Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage Renal Disease Initiating Hemodialysis

Abstract

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 patient-important outcomes is not well defined. Objectives We determined prevalence of ECHO determined SHD and its association with survival among incident HD patients. Methods We analyzed patients initiating chronic HD from 2001-2013 who underwent ECHO ≤ 1 month prior to or ≤ 3 months following HD initiation (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 gender-adjusted structural heart disease variables associated with death were left ventricular ejection fraction (LEVF) ≤ 45% (HR 1.48, CI 1.20-1.83) and right ventricular (RV) systolic dysfunction (HR 1.68, CI 1.35-2.07). An additive of higher death risk included LVEF ≤ 45% and RV systolic dysfunction rather than neither (HR 2.04, CI 1.57-2.67; p = 0.53 for test for interaction). Following adjustment for age, gender, race, diabetic kidney disease, and dialysis access, RV dysfunction was independently associated with death (HR 1.66; CI 1.34-2.06; p < 0.001). Conclusions SHD was common in our hemodialysis study population, and RV systolic dysfunction independently predicted mortality.

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