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Chisavu LA, Apostol A, Pop GN, Ivan V, Schiller O, Bob F, Marc L, Mihaescu A, Gadalean F, Grosu I, Timar B, Schiller A. Exploring the relation between mortality and left ventricular structure and function in stable hemodialysis treated patients, a longitudinal multicenter cohort study. Sci Rep 2021; 11:12694. [PMID: 34135351 PMCID: PMC8209211 DOI: 10.1038/s41598-021-91431-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/19/2021] [Indexed: 12/24/2022] Open
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.
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Affiliation(s)
- Lazar A Chisavu
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Avitum BBraun, Timisoara, Romania
| | - Adrian Apostol
- Department of Internal Medicine II - Division of Cardiology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Cardiology Clinic- County Emergency Hospital "Pius Brinzeu", Timisoara, Romania
| | - Gheorghe N Pop
- Department of Cardiology VI - Division of Outpatient Internal Medicine, Cardiovascular Prevention and Recovery, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania. .,Department of Functional Sciences, Centre for Modeling Biological Systems and Data Analysis, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
| | - Viviana Ivan
- Department of Internal Medicine II - Division of Cardiology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Cardiology Clinic- County Emergency Hospital "Pius Brinzeu", Timisoara, Romania
| | | | - Flaviu Bob
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timisoara, Romania
| | - Luciana Marc
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Avitum BBraun, Timisoara, Romania
| | - Adelina Mihaescu
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timisoara, Romania
| | - Florica Gadalean
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timisoara, Romania
| | - Iulia Grosu
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timisoara, Romania
| | - Bogdan Timar
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Diabetes and Metabolic Diseases Clinic - County Emergency Hospital "Pius Brinzeu", Timisoara, Romania
| | - Adalbert Schiller
- Department of Internal Medicine II - Division of Nephrology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Nephrology Clinic - County Emergency Hospital "Pius Brinzeu", Timisoara, Romania
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