Related Experiment Video
Updated: Oct 25, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Diastolic and systolic left ventricular dysfunction and mortality in chronic kidney disease patients on haemodialysis
Jose J G De Lima1, Thiago A Macedo1, Luis Henrique W Gowdak1
1Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Insights
Left ventricular diastolic dysfunction (LVDD) and LV systolic dysfunction (LVSD) independently predict mortality in hemodialysis patients. Both conditions significantly increase death risk, with LVDD showing a progressive association with mortality across severity grades.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- Left ventricular diastolic dysfunction (LVDD) and LV systolic dysfunction (LVSD) are common in chronic kidney disease (CKD).
- The independent prognostic value of LVDD and LVSD in CKD patients on hemodialysis remains debated.
- Understanding their impact on mortality is crucial for risk stratification.
Purpose of the Study:
- To determine if LVDD and LVSD independently predict all-cause mortality in hemodialysis patients.
- To compare the prognostic impact of LVDD and LVSD on patient outcomes.
- To investigate the association between LVDD severity and mortality risk.
Main Methods:
- Retrospective analysis of echocardiographic data from 1285 hemodialysis patients.
- Classification of LVDD into four grades of severity.
- Follow-up until death or transplantation to assess all-cause mortality.
Main Results:
- Moderate-to-severe LVDD and LVSD independently predicted death in hemodialysis patients.
- A progressive association was observed between LVDD grades and increased mortality risk.
- The impact of moderate-to-severe LVDD on mortality risk was comparable to that of LVSD.
Conclusions:
- Moderate-to-severe LVDD and LVSD are independent predictors of mortality in hemodialysis patients.
- Both LVDD and LVSD have a similar, significant impact on patient survival.
- LVDD severity is progressively associated with increased mortality.
Aims:
Left ventricular diastolic dysfunction (LVDD) and LV systolic dysfunction (LVSD) are prevalent in CKD, but their prognostic relevance is debatable. We intent to verify whether LVDD and LVSD are independently predictive of all-cause mortality and if they have comparable or different effects on outcomes.
Methods:
A retrospective analysis was conducted of the echocardiographic data of 1285 haemodialysis patients followed up until death or transplantation. LVDD was classified into 4 grades of severity. Endpoint was all-cause mortality.
Results:
During a follow-up of 30 months, 419/1285 (33%) patients died, 224 (53%) due to CV events. LVDD occurred in 75% of patients, grade 1 DD was the prevalent diastolic abnormality, and pseudonormal pattern was the predominant form of moderate-severe DD. Moderate-severe LVDD (HR 1.379, CI% 1.074-1.770) and LVSD (HR 1.814, CI% 1.265-2.576) independently predicted death; a graded, progressive association was found between LVDD categories and the risk of death; and the impact of isolated severe-moderate LVDD on the risk of death was comparable to that exercised by isolated compromised LV systolic function.
Conclusion:
Moderate-severe LVDD and LVSD were independently associated with a higher probability of death and had a similar impact on survival. A progressive association was observed between LVDD grades and mortality.
Related Concept Videos
01:22Heart Failure Drugs: Diuretics
01:18Chronic Kidney Disease IV: Nursing Management
01:24Chronic Kidney Disease II: Clinical Manifestations
01:25Chronic Kidney Disease I: Introduction
01:29Heart Failure II: Pathophysiology
01:28Chronic Kidney Disease III: Interprofessional Care