Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study

Abstract Background Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on mainte...

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Main Authors: Anna Axelsson Raja, Peder E. Warming, Ture L. Nielsen, Louis L. Plesner, Mads Ersbøll, Morten Dalsgaard, Morten Schou, Casper Rydahl, Lisbet Brandi, Kasper Iversen
Format: Article
Language:English
Published: BMC 2020-09-01
Series:BMC Nephrology
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12882-020-02074-3
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spelling doaj-48cb4f9aff124c54b899c8cbbc18f5962020-11-25T02:50:03ZengBMCBMC Nephrology1471-23692020-09-012111910.1186/s12882-020-02074-3Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational studyAnna Axelsson Raja0Peder E. Warming1Ture L. Nielsen2Louis L. Plesner3Mads Ersbøll4Morten Dalsgaard5Morten Schou6Casper Rydahl7Lisbet Brandi8Kasper Iversen9Department of Cardiology, Copenhagen University Hospital HerlevDepartment of Cardiology, Copenhagen University Hospital HerlevDepartment of Cardiology, Copenhagen University Hospital HerlevDepartment of Cardiology, Copenhagen University Hospital HerlevDepartment of Cardiology, Copenhagen University Hospital RigshopitaletDepartment of Cardiology, Copenhagen University Hospital HerlevDepartment of Cardiology, Copenhagen University Hospital HerlevDepartment of Nephrology, Copenhagen University Hospital HerlevDepartment of Cardiology, Endocrinology and Nephrology, Copenhagen University Hospital Nordsjaellands HospitalDepartment of Cardiology, Copenhagen University Hospital HerlevAbstract Background Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on maintenance haemodialysis we aimed to assess: the prevalence of structural and functional heart disease, the potential therapeutic consequences of echocardiographic screening and whether left-sided heart disease is associated with prognosis. Methods Adult chronic haemodialysis patients in two large dialysis centres had transthoracic echocardiography performed prior to dialysis and were followed prospectively. Significant left-sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%. Results Among the 247 included patients (mean 66 years of age [95%CI 64–67], 68% male), 54 (22%) had significant left-sided heart disease. An LVEF ≤40% was observed in 31 patients (13%) and severe or moderate valve disease in 27 (11%) patients. The findings were not previously recognized in more than half of the patients (56%) prior to the study. Diagnosis had a potential impact on management in 31 (13%) patients including for 18 (7%) who would benefit from initiation of evidence-based heart failure therapy. After 2.8 years of follow-up, all-cause mortality among patients with and without left-sided heart disease was 52 and 32% respectively (hazard ratio [HR] 1.95 (95%CI 1.25–3.06). A multivariable adjusted Cox proportional hazard analysis showed that left-sided heart disease was an independent predictor of mortality with a HR of 1.60 (95%CI 1.01–2.55) along with age (HR per year 1.05 [95%CI 1.03–1.07]). Conclusion Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage kidney failure on haemodialysis and are associated with a higher risk of death. For more than 10% of the included patients, systematic echocardiographic assessment had a potential clinical consequence.http://link.springer.com/article/10.1186/s12882-020-02074-3CardiovascularEnd-stage renal failureDialysisEchocardiographyLeft ventricular systolic dysfunctionHeart failure
collection DOAJ
language English
format Article
sources DOAJ
author Anna Axelsson Raja
Peder E. Warming
Ture L. Nielsen
Louis L. Plesner
Mads Ersbøll
Morten Dalsgaard
Morten Schou
Casper Rydahl
Lisbet Brandi
Kasper Iversen
spellingShingle Anna Axelsson Raja
Peder E. Warming
Ture L. Nielsen
Louis L. Plesner
Mads Ersbøll
Morten Dalsgaard
Morten Schou
Casper Rydahl
Lisbet Brandi
Kasper Iversen
Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
BMC Nephrology
Cardiovascular
End-stage renal failure
Dialysis
Echocardiography
Left ventricular systolic dysfunction
Heart failure
author_facet Anna Axelsson Raja
Peder E. Warming
Ture L. Nielsen
Louis L. Plesner
Mads Ersbøll
Morten Dalsgaard
Morten Schou
Casper Rydahl
Lisbet Brandi
Kasper Iversen
author_sort Anna Axelsson Raja
title Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
title_short Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
title_full Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
title_fullStr Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
title_full_unstemmed Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
title_sort left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study
publisher BMC
series BMC Nephrology
issn 1471-2369
publishDate 2020-09-01
description Abstract Background Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on maintenance haemodialysis we aimed to assess: the prevalence of structural and functional heart disease, the potential therapeutic consequences of echocardiographic screening and whether left-sided heart disease is associated with prognosis. Methods Adult chronic haemodialysis patients in two large dialysis centres had transthoracic echocardiography performed prior to dialysis and were followed prospectively. Significant left-sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%. Results Among the 247 included patients (mean 66 years of age [95%CI 64–67], 68% male), 54 (22%) had significant left-sided heart disease. An LVEF ≤40% was observed in 31 patients (13%) and severe or moderate valve disease in 27 (11%) patients. The findings were not previously recognized in more than half of the patients (56%) prior to the study. Diagnosis had a potential impact on management in 31 (13%) patients including for 18 (7%) who would benefit from initiation of evidence-based heart failure therapy. After 2.8 years of follow-up, all-cause mortality among patients with and without left-sided heart disease was 52 and 32% respectively (hazard ratio [HR] 1.95 (95%CI 1.25–3.06). A multivariable adjusted Cox proportional hazard analysis showed that left-sided heart disease was an independent predictor of mortality with a HR of 1.60 (95%CI 1.01–2.55) along with age (HR per year 1.05 [95%CI 1.03–1.07]). Conclusion Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage kidney failure on haemodialysis and are associated with a higher risk of death. For more than 10% of the included patients, systematic echocardiographic assessment had a potential clinical consequence.
topic Cardiovascular
End-stage renal failure
Dialysis
Echocardiography
Left ventricular systolic dysfunction
Heart failure
url http://link.springer.com/article/10.1186/s12882-020-02074-3
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