Left ventricular mass index and aortic arch calcification score are independent mortality predictors of maintenance hemodialysis patients

Abstract

To analyze predictive factors for all‐cause mortality, cardiovascular (CV) mortality, nonfatal CV events (CVE) in maintenance hemodialysis (MHD) patients, and to compare the effects of standard hemodialysis (HD) and online hemodiafiltration (HDF) on these factors and outcomes. A total of 333 MHD patients were prospectively followed up for 50 ± 15 months and all‐cause death, CV death and CVE were registered. At the baseline, demographic, clinical, and laboratory data of the whole population were recorded. Then, patients were stratified into two groups according to the dialysis modalities, HD (n = 268) and HDF (n = 65). At the end of 6th month, clinical and laboratory data were recorded again. The predictive factors at baseline for all‐cause mortality, CV mortality, and CVE were analyzed by Cox regression. The effects of HD and HDF on these factors at the 6th month and long‐term outcomes were compared by t‐test and Kaplan–Meier method, respectively. Age, gender, left ventricular mass index (LVMI), aortic arch calcification score (AoACS), hemoglobin (Hb) <10 g/dL, and ferritin >500 ng/mL maintained independent associations with all‐cause mortality. C‐reactive protein (CRP), LVMI, AoACS, and Hb <10 g/dL were associated with CV mortality. Prior cardiovascular disease (CVD), AoACS and LVMI were independent predictors of nonfatal CVE. Higher body mass index (BMI), body weight, total serum cholesterol, Hb concentration, and lower CRP level, LVMI, and AoACS were found in patients on HDF at the end of the 6th month. Improved outcomes with longer survival time for all‐cause mortality, CV mortality, and CVE were found in HDF group. Age, gender, LVMI, AoACS, Hb, and ferritin were predictors of all‐cause mortality in MHD patients. CRP, LVMI, AoACS, and Hb were associated with CV mortality. Prior CVD, AoACS, and LVMI were independent predictors of nonfatal CVE. HDF could improve BMI, body weight, total serum cholesterol, Hb, CRP, LVMI, AoACS, and long‐term outcomes, including all‐cause mortality, CV mortality, and CVE.

A Randomized Trial of Hemodiafiltration and Change in Cardiovascular Parameters

“…In our analyses, LVM was not indexed for body surface area or divided by height 2.7 , as was done in analogous studies (22,25,26). A downside of ratios is that an observed relation may be due to changes in the nominator, the denominator, or both.…”

“…In two observational studies comparing HDF and HD performed in 118 patients (HDF, n=58) and 333 patients (HDF, n=65), LVM index decreased in the HDF group and remained stable in the HD group over a follow-up period of 2 and 4 years, respectively (25,26). However, nonrandomized studies are prone to confounding by indication: It cannot be ruled out that patients with a more favorable prognosis were allocated to HDF.…”

Comparison of the effects of hemodialysis and hemodiafiltration on left ventricular hypertrophy in end‐stage renal disease patients: A systematic review and meta‐analysis

“…However, high convection volumes (>18.8 L) was not related to change of left ventricular mass and EF . Liu et al performed online HDF using high‐flux polysulphone membranes with 14.4 L/session convection volume . Schiffl et al used post‐dilution online HDF with volumes of 18.0‐22.5 L per session .…”

“…Moreover, the number of studies included in the analysis was relatively small and only two studies were prospective, randomized, controlled trials. The length of follow‐up of measurements was extremely heterogeneous with a range of 3 months to 4 years …”

Increased Frequency of In-Center Hemodialysis as Rescue Therapy: Impact on Hospitalization for Acute Cardiovascular Events

“…Moreover, Liu et al [26] reported that the LVMI was an independent mortality predictor of maintenance HD patients. According to another previous study, increased LVEDD was an independent predictor of all-cause mortality [27].…”