Abstract
Left ventricular (LV) structure and function anomalies are frequent during the CKD continuum and are associated with increased risk of mortality. Cross section and longitudinal ultrasound data are available for advanced CKD and transition to ESKD. Less information is available about LV changes during stable, long-term hemodialysis (HD) treatment. All stable HD patients from 9 HD centers (1034 patients, 671 males, age 58.71 ± 12.94 years) have been enrolled in January 2015. The cohort was followed-up for 4 years, kidney transplantation or death. Yearly, two-dimensional and M-mode continuous and Pulse Doppler echocardiography were performed. During the follow-up, the prevalence of cardiovascular comorbidities significantly increased (p < 0.0001), coronary artery disease (CAD) from 73.5 to 88.8%, peripheral artery disease (PAD) from 29 to 40.9%, cerebral vascular disease (CVD) from 20.4 to 30.8%, heart valves calcification (VC) from 65.6 to 89.3% and left ventricular hypertrophy (LVH) from 67.6 to 76.5%. The mortality risk increased with the presence of CAD (1.59-fold), PAD (1.61-fold), CVD (1.59-fold), and VC (1.77-fold). Mortality risk was increased in those with LVEF < 50% (LVEF 40–49% 1.5-fold and LVEF < 40% 2.3 fold). Among the survivors of the first year, LVEF varied (> 5% decrease, > 5% increase and ± 5% variations). More than 5% increase of LVEF was associated with higher mortality risk (crude 1.5-fold, adjusted 1.43-fold) compared to stationary EF (p = 0.001). Cardiovascular disease progresses during stable long-term HD therapy and increases mortality risk. HF becomes highly prevalent but only HF with decreased LVEF < 50% is associated with increased risk of mortality.
Highlights
Left ventricular (LV) structure and function anomalies are frequent during the chronic kidney disease (CKD) continuum and are associated with increased risk of mortality
The prevalence of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients is twofold higher as compared to the no CKD general population (65.1% vs. 32.6%) and it increases with age and kidney function
Less is known about long-term HD therapy and its effects on myocardial structure and function under the novel conditions: anemia and erythropoietin stimulating agents (ESA) therapy, chronic kidney disease–mineral bone disorder (CKD-MBD) and its treatment, fluid overload, novel blood pressure conditions, novel diet and metabolism conditions, and so on
Summary
Left ventricular (LV) structure and function anomalies are frequent during the CKD continuum and are associated with increased risk of mortality. The prevalence of cardiovascular disease (CVD) in chronic kidney disease (CKD) patients is twofold higher as compared to the no CKD general population (65.1% vs 32.6%) and it increases with age and kidney function. The mortality of hemodialysis (HD) treated ESRD patients is very high compared to the general population (in Europe 8.8-fold higher for CVD and 8.1-fold higher for non-cardiovascular causes)[2]. In these patients, CVD remains the main cause of death. Less is known about long-term HD therapy and its effects on myocardial structure and function under the novel conditions: anemia and erythropoietin stimulating agents (ESA) therapy, chronic kidney disease–mineral bone disorder (CKD-MBD) and its treatment, fluid overload, novel blood pressure conditions, novel diet and metabolism conditions, and so on
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