Association of echocardiographic abnormalities with mortality in men with non-dialysis-dependent chronic kidney disease

• Published in: Nephrology, dialysis, transplantation Vol. 27; no. 2; pp. 694 - 700
• Main Authors: PAYNE, Jason, SHARMA, Smriti, DE LEON, Dexter, LU, Jun L, ALEMU, Fregenet, BALOGUN, Rasheed A, MALAKAUSKAS, Sandra M, KALANTAR-ZADEH, Kamyar, KOVESDY, Csaba P
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.02.2012
• Subjects: Age Distribution; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cause of Death; Cohort Studies; Comorbidity; Echocardiography, Doppler - methods; Emergency and intensive care: renal failure. Dialysis management; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - mortality; Hypertrophy, Left Ventricular - therapy; Incidence; Intensive care medicine; Kaplan-Meier Estimate; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Linear Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Original; Prognosis; Proportional Hazards Models; Renal Dialysis; Renal failure; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Severity of Illness Index; Stroke Volume; Survival Analysis; Human; Kidney disease; chronic kidney disease; Urinary system disease; Echocardiography; Hemodialysis; Mortality; Left ventricle; Extrarenal dialysis; left ventricular hypertrophy; Renal failure; Dialysis; Ejection fraction
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfr282

The interrelationship of left ventricular hypertrophy (LVH) with ejection fraction (EF) and their impact on mortality in non-dialysis-dependent chronic kidney disease (NDD-CKD) is unclear. We examined the associations of EF and LVH with all-cause mortality in a historic cohort of 650 male US veterans with moderate-to-advanced NDD-CKD. EF and LVH were examined both separately and after categorizing patients according to their concomitant EF and presence/absence of LVH. Associations with mortality were examined in Cox models with adjustments for demographics, blood pressure, comorbidities, smoking status, medication use and biochemical characteristics. EF <30 and 30-50% were associated with higher all-cause mortality compared to EF >50% even after multivariable adjustments [multivariable adjusted hazard ratio, 95% confidence interval (CI): 2.83 (1.86-4.30) and 1.38 (1.06-1.78), P < 0.001 for linear trend]. LVH in itself was not associated with mortality [multivariable adjusted hazard ratio, 95% CI: 0.83 (0.66-1.05), P = 0.12], but the presence of LVH combined with an EF <50% was associated with the highest mortality [multivariable adjusted hazard ratios, 95% CI in patients with EF >50% + LVH, EF ≤ 50%-LVH and EF ≤ 50% + LVH, compared to EF >50%-LVH: 0.84 (0.63-1.13), 1.36 (1.00-1.83) and 1.62 (1.07-2.46)]. Low EF is associated with higher mortality in patients with NDD-CKD. In the presence of a low EF, LVH is also associated with higher mortality. Clinical trials are needed to determine if interventions targeting patients with low EF and LVH can lower mortality in NDD-CKD.