Ventricular ejection fraction over time in patients on intensive home hemodialysis: A retrospective cohort study

Intensive hemodialysis has been demonstrated to have several beneficial cardiovascular effects. There is a paucity of studies examining the effect of intensive home hemodialysis (IHHD) on left ventricular ejection fraction (LVEF).

We conducted a retrospective cohort study at the Toronto General Hospital including all IHHD patients between 1999 and 2017 with baseline and follow-up echocardiograms for at least a year. Patients were categorized according to LVEF at follow-up: patients with normal and patients with abnormal LVEF and/or a decline in LVEF. Normal LVEF was defined as ≥55% and a decline as ≥5% at follow-up compared to baseline Cox regression analyses were performed to ascertain the association between reduced LVEF and reaching the composite endpoint of death, cardiovascular hospitalization, and technique failure, respectively. Multivariate logistic analysis was used to investigate possible risk factors for changes in LVEF.

A total of 154 patients were included in the study. At baseline, 18.8% (29/154) of patients had reduced LVEF. After a mean follow-up of 3.9 years, overall mean LVEF did not change (59.3% [at follow-up] vs. 59.9% [baseline], P = 0.45). Seventeen out of the 130 patients with normal LVEF (13.1%) and nine out of the 24 with abnormal LVEF (37.9%) reached the composite endpoint of death, cardiovascular hospitalization, or technique failure. Reduced LVEF at baseline odds ratio ((OR) 13.26 [95% confidence interval (CI) 4.62-38.05]) as well as coronary heart disease (OR 7.82 [95% CI 1.92-31.82]) were associated with reduced ejection fraction at follow-up. When adjusted for age and diabetes, patients with abnormal LVEF were more likely to reach the composite endpoint hazard ratio ((HR) 3.85, 95% CI 1.70-8.71). We did not identify a risk factor associated with progression or worsening of LVEF.

Preserved LVEF occurs in most patients on IHHD and is associated with better clinical outcomes. Further studies are needed to identify the mechanism affecting left ventricular function in patients undergoing intensive hemodialysis.