Survival and heart failure therapy in chronic dialysis patients with heart failure and reduced left ventricular...

We retrospectively followed 250 patients who started dialysis between 2005 and 2009 to clarify the prevalence, the prognosis and the prescribed heart failure treatment of systolic heart failure patients on dialysis.

This cohort was divided according to left ventricular ejection fraction (LVEF): group A with a reduced LVEF (< or = 45%, n = 45) versus group B with a preserved LVEF (> 45%, n = 205). Patients in group A had a significantly worse survival after 12 and 24 months (68.9% and 55.5% vs. 87.3% and 73.0%, respectively, P = 0.0001). Hazard ratio for all-cause mortality was 2.70 (C.I. 95% 1.6 - 4.56, P = 0.0002). In the subgroup of patients with a LVEF < 30% the hazard ratio increased to 3.45 (C.I. 95% 1.71 - 6.94, P = 0.0005). The cumulative incidence of cardiovascular death was significantly higher in group A (hazard ratio: 4.78 (C.I. 95% 1.99- 11.50, P = 0.0005), especially in the subgroup with a LVEF < 30%. In group A 71%, 31% and 9% of the patients received a beta blocker, an ACE inhibitor and an angiotensin-receptor blocker, respectively. Only 27% were treated with the combination of a beta blocker and a RAAS inhibitor, while 18% did not receive any heart failure therapy. Most patients only received a low dose of neurohormonal blockers (< or = 25% of the recommended daily dose). The use of these heart failure medications was not significantly different between group A and B.

After initiation of dialysis, patients with heart failure and reduced LVEF have a bad prognosis. Only a minority of these patients receive adequate specific heart failure treatment.