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Updated: Oct 9, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Associations between Myocardial Diastolic Dysfunction and Cardiovascular Mortality in Chronic Kidney Disease: A Large
Hsin-Yueh Liang1, Ya-Luan Hsiao2, Hung-Chieh Yeh3
1Division of Cardiology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan.
Insights
Diastolic dysfunction (DD) and reduced left ventricular ejection fraction (LVEF) significantly increase cardiovascular mortality risk in chronic kidney disease (CKD) patients. Early cardioprotection is crucial alongside nephroprotection for CKD management.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- The prognostic significance of diastolic dysfunction (DD) in chronic kidney disease (CKD) patients, per 2016 ASE guidelines, is not fully understood.
- Risk stratification for cardiovascular (CV) mortality considering both systolic dysfunction and DD in CKD patients remains unexplored.
Purpose of the Study:
- To clarify the clinical burden and prognostic role of DD in CKD patients.
- To map the risk of CV mortality associated with systolic dysfunction and DD in different stages of CKD.
Main Methods:
- Retrospective cohort study of 20,257 adult CKD patients undergoing echocardiography (2008-2016).
- Patients stratified by CKD stage.
- Multivariable Cox proportional-hazards modeling used to estimate 3-year CV mortality risk based on left ventricular ejection fraction (LVEF) and DD grade (2016 ASE guidelines).
Main Results:
- Patients with advanced CKD (stages 4-5) exhibited lower LVEF and more severe DD compared to stages 1-2.
- Both reduced LVEF (<40%) and severe DD were independent predictors of 3-year CV mortality (aHRs 3.17 and 3.33, respectively).
- The combined effect of systolic dysfunction and DD significantly augmented CV mortality risk, particularly in advanced CKD stages.
Conclusions:
- Both diastolic dysfunction and impaired left ventricular ejection fraction are significant, independent predictors of cardiovascular mortality in CKD.
- These cardiac abnormalities have mutually augmentative effects on mortality risk.
- Prioritizing early cardioprotection alongside nephroprotection is recommended for patients with chronic kidney disease.
Background:
The clinical burden and prognostic role of diastolic dysfunction (DD), on the basis of the latest (2016) American Society of Echocardiography guidelines, remain unclear in patients with chronic kidney disease (CKD). Moreover, risk mapping of concomitant systolic dysfunction and DD to evaluate the hazard of cardiovascular (CV) mortality in patients with CKD remains unexplored.
Methods:
This retrospective cohort study identified 20,257 adult patients who underwent comprehensive echocardiography between 2008 and 2016 at a tertiary medical center in central Taiwan. The patients were stratified by CKD stage, and 3-year CV mortality risk in each CKD stratum was estimated through multivariable Cox proportional-hazards modeling using left ventricular ejection fraction (LVEF) and DD grades on the basis of the 2016 American Society of Echocardiography guidelines as the main risk factors.
Results:
Compared with patients with stages 1 and 2 CKD, those with stages 4 and 5 CKD had significantly lower left ventricular ejection fractions and more severe DD. Both left ventricular ejection fraction (<40% vs ≥60%; adjusted hazard ratio, 3.17; 95% CI, 2.54-3.97) and DD grade (severe DD vs normal diastolic function; adjusted hazard ratio, 3.33; 95% CI, 2.33-4.76) were independently associated with 3-year CV mortality in the entire study population and had comparable effect sizes. The corresponding adjusted hazard ratios further increased to 4.20 (95% CI, 2.45-7.21) and 4.54 (95% CI, 2.20-9.38) in patients with stages 4 and 5 CKD. Systolic dysfunction and DD demonstrated mutually augmentative effects on CV mortality.
Conclusions:
These findings suggest that the current practice of cardioprotection for patients with CKD should be prioritized at an early stage along with conventional nephroprotection.
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