Echocardiographic Parameters as Cardiovascular Mortality Predictors in Chronic Hemodialysis Patients

Misato Koeda, Tetsuya Ogawa, Kyoko Ito, Takaaki Tsutsui, Kosaku Nitta

Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan.
Department of Medicine, Medical Center East, Tokyo Women’s Medical University, Tokyo, Japan.
Department of Nephrology, Hidaka Hospital, Gunma, Japan.

DOI: 10.4236/ijcm.2014.512087                

Abstract

Background: Hemodialysis (HD) patients have high rates of cardiovascular (CV) mortality. Although structural and functional echocardiographic alterations in HD patients have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established. The aim of this study was to determine the prognostic value of echocardiographic parameters in chronic HD patients. Objectives: One hundred eighteen HD patients were clinically evaluated and underwent Doppler echocardiography, being followed for 45.7 ± 13.6 months. The outcome measures were CV mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log-rank test to compare them. Results: CV diseases accounted for 46.4% of all deaths during the follow-up period. We found that the event-free survival rates in one and two years were 96.5% and 83.0%, respectively. Diabetes and E/e' ratio were predictors of CV outcome by multivariate analyses. Conclusion: Diabetes and diastolic dysfunction are independent predictors of CV mortality in chronic HD patients.

Keywords

Diastolic Dysfunction, Echocardiography, Hemodialysis, Cardiovascular Mortality, Prognosis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	United States Data System. 2010 Annual Data Report. Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2010.
[2]	Nakai, S., Watanabe, Y., Masakane, I., Wada, A., Shoji, T. Hasegawa, T., et al. (2013) Overview of Regular Dialysis Treatment in Japan (as of 31 December 2011). Therapeutic Apheresis and Dialysis, 17, 567-611. http://dx.doi.org/10.1111/1744-9987.12147
[3]	Parfrey, P.S. and Foley, R.N. (1999) The Clinical Epidemiology of Cardiac Disease in Chronic Renal Failure. Journal of American Society of Nephrology, 10, 1606-1615.
[4]	Fujiu, A., Ogawa, T., Matsuda, N., Ando, Y. and Nitta, K. (2008) Aortic Arch Calcification and Arterial Stiffness Are Independent Factors for Diastolic Left Ventericular Dysfunction in Chronic Hemodialysis Patients. Circulation Journal, 72, 1768-1772. http://dx.doi.org/10.1253/circj.CJ-08-0308
[5]	Yamazaki, M., Ogawa, T., Tamei, N., Ando, Y. and Nitta, K. (2011) Relation of N-Terminal pro-B-Type Natriuretic Peptide (NT-proBNP) and Left Atrial Volume Index to Left Ventricular Function in Chronic Hemodialysis Patients. Heart Vessels, 26, 421-427. http://dx.doi.org/10.1007/s00380-010-0066-4
[6]	London, G.M., Pannier, B., Guerin, A.P., Blacher, J., Marchais, S.J., Darne, B., et al. (2001) Alterations of Left Ventricular Hypertrophy in and Survival of Patients Receiving Hemodialysis: Follow-Up of An Interventional Study. Journal of American Society of Nephrology, 12, 2759-2767.
[7]	Zoccali, C., Benedetto, F.A., Mallamaci, F., Tripepi, G., Giacone, G., Cataliotti, A., et al. (2004) Prognostic Value of Echocardiographic Indicators of Left Ventricular Systolic Function in Asymptomatic Dialysis Patients. Journal of American Society of Nephrology, 15, 1029-1037. http://dx.doi.org/10.1097/01.ASN.0000117977.14912.91
[8]	Chen, S.C., Chang, J.M., Liu, W.C., Huang, J.C., Tsai, J.C., Lin, M.Y., et al. (2012) Echocardiographic Parameters Are Independently Associated with Increased Cardiovascular Events in Patients with Chronic Kidney Disease. Nephrology Dialysis Transplantation, 27, 1064-1070. http://dx.doi.org/10.1093/ndt/gfr407
[9]	Iwabuchi, Y. Ogawa, T., Inoue T, Otsuka, K., Nitta, K. (2012) Elevated E/E' Predicts Cardiovascular Events in Hemodialysis Patients with Preserved Systolic Function. Internal Medicine, 51, 155-160. http://dx.doi.org/10.2169/internalmedicine.51.6250
[10]	Schiller, N.B., Shah, P.M., Crawford, M., DeMaria, A., Devereux, R., Feigenbaum, H., et al. (1989) Recommendations for Quantitation of the Left Ventricle by Two-Dimensional Echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. Journal of American Society of Echocardiography, 2, 358-367.
[11]	Quiñones, M.A., Otto, C.M., Stoddard, M., Waggoner, A. and Zoghbi, W.A. (2002) Recommendations for Quantification of Doppler Echocardiography: A Report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Journal of American Society of Echocardiograpy, 15, 167-184. http://dx.doi.org/10.1067/mje.2002.120202
[12]	Nagueh, S.F., Appleton, C.P., Gillebert, T.C., Marino, P.N., Oh, J.K., Smiseth, O.A., et al. (2009) Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography. Journal of American Society of Echocardiography, 22, 107-133. http://dx.doi.org/10.1016/j.echo.2008.11.023
[13]	Devereux, R.B., Alonso, D.R., Lutas, E.M., Gottlieb, G.J., Campo, E., Sachs, I., et al. (1986) Echocardiographic Assessment of Left Ventricular Hypertrophy: Comparison to Necropsy Findings. American Journal of Cardiology, 57, 450-458. http://dx.doi.org/10.1016/0002-9149(86)90771-X
[14]	Teichholz, L.E., Kreulen, T., Herman, M.V. and Gorlin, R. (1976) Problems in Echocardiographic Volume Determinations: Echocardiographic-Angiographic Correlations in the Presence or Absence of Asynergy. American Journal of Cardiology, 37, 7-11. http://dx.doi.org/10.1016/0002-9149(76)90491-4
[15]	Kasner, M., Westermann, D., Steendijk, P., Gaub, R., Wilkenshoff, U., Weitmann, K., et al. (2007) Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Diastolic Function in Heart Failure with Normal Ejection Fraction: A Comparative Doppler-Conductance Catheterization Study. Circulation, 116, 637-647. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.661983
[16]	Khouri, S.J., Maly, G.T., Suh, D.D. and Walsh, T.E. (2004) A Practical Approach to the Echocardiographic Evaluation of Diastolic Function. Journal of the American Society of Echocardiograpy, 17, 290-297. http://dx.doi.org/10.1016/j.echo.2003.08.012
[17]	Dubois, D. and Dubois, E.F. (1916) A Formula to Estimate the Approximate Surface Area If Height and Weight be Known. JAMA Internal Medicine, 17, 863-871. http://dx.doi.org/10.1001/archinte.1916.00080130010002
[18]	Siqueira, T.M., Ferreira, P.A., das Chagas Monteiro Junior, F., Salqado Fiho, N., Ferreira Ade, S., Santos Neto, E.D., et al. (2012) Echocardiographic Parameters as Cardiovascular Event Predictors in Hemodialysis Patients. Arquivos Brasileiros de Cardiologia, 99, 714-723. http://dx.doi.org/10.1590/S0066-782X2012005000065
[19]	Cheung, A.K., Sarnak, M.J., Yan, G., Berkoben, M., Heyka, R., Kaufman, A., et al. (2004) Cardiac Diseases in Maintenance Hemodialysis Patients: Results of the HEMO Study. Kidney International, 65, 2380-2389. http://dx.doi.org/10.1111/j.1523-1755.2004.00657.x
[20]	Fellström, B.C., Jardine, A.G., Schmieder, R.E., Holdaas, H., Bannister, K., Beutler, J., et al. (2009) Rosuvastatin and Cardiovascular Events in Patients Undergoing Hemodialysis. New England Journal of Medicine, 360, 1395-1407. http://dx.doi.org/10.1056/NEJMoa0810177
[21]	Foley, R.N., Parfrey, P.S. and Sarnak, M.J. (1998) Clinical Epidemiology of Cardiovascular Disease in Chronic Renal Disease. American Journal of Kidney Diseases, 32, S112-S119. http://dx.doi.org/10.1053/ajkd.1998.v32.pm9820470
[22]	Zoccali, C., Mallamaci, F. and Tripepi, G. (2004) Novel Cardiovascular Risk Factors in End-Stage Renal Disease. Journal of the American Society of Nephrology, 15, S77-S80. http://dx.doi.org/10.1097/01.ASN.0000093240.84097.FE
[23]	Foley, R.N., Culleton, B.F., Parfrey, P.S., Harnett, J.D., Kent, G.M., Murray, D.C., et al. (1997) Cardiac Disease in Diabetic End-Stage Renal Disease. Diabetologia, 40, 1307-1312. http://dx.doi.org/10.1007/s001250050825
[24]	Burchfiel, C.M., Reed, D.M., Marcus, E.B., Strong, J.P. and Hayashi, T. (1993) Association of Diabetes Mellitus with Coronary Atherosclerosis and Myocardial Lesions. An Autopsy Study from the Honolulu Heart Program. American Journal of Epidemiology, 137, 1328-1340.
[25]	Kannel, W.B., Hjortland, M. and Castelli, W.P. (1974) Role of Diabetes in Congestive Heart Failure: The Framingham Study. American Journal of Cardiology, 34, 29-34. http://dx.doi.org/10.1016/0002-9149(74)90089-7
[26]	Galderisi, M., Anderson, K.M., Wilson, P.W. and Levy, D. (1991) Echocardiographic Evidence for the Existence of a Distinct Diabetic Cradiomyopathy (The Framingham Heart Study). American Journal of Cardiology, 68, 85-89. http://dx.doi.org/10.1016/0002-9149(91)90716-X
[27]	Nardi, E., Palermo, A., Mule, G., Cusimano, P., Cottone, S. and Cerasola, G. (2011) Impact of Type 2 Diabetes on Left Ventricular Geometry and Diastolic Function in Hypertensive Patients with Chronic Kidney Disease. Journal of Human Hypertension, 25, 144-151. http://dx.doi.org/10.1038/jhh.2010.96
[28]	Hung, K.C., Lee, C.H., Chen, C.C., Chu, C.M., Wang, C.Y., Hsieh, I.C., et al. (2012) Advanced Left Ventricular Diastolic Dysfunction in Uremic Patients with Type 2 Diabetes on Maintenance Hemodialysis. Circulation Journal, 76, 2380-2385. http://dx.doi.org/10.1253/circj.CJ-12-0471
[29]	Kunz, K., Dimitrov, Y., Muller, S., Chantrel, F. and Hannedouche, T. (1998) Uraemic Cardiomyopathy. Nephrology Dialysis Transplantation, 13, 39-43.
[30]	Zaslavsky, L.M., Pinotti, A.F. and Gross, J.L. (2005) Diastolic Dysfunction and Mortality in Diabetic Patients on Hemodilaysis: A 4.25-Year Controlled Prospective Study. Journal of Diabetes and Its Complications, 19, 194-200. http://dx.doi.org/10.1016/j.jdiacomp.2004.12.001
[31]	Herzog, C.A., Asinger, R.W., Berger, A.K., Charytan, D.M., Díez, J., Hart, R.G., et al. (2011) Cardiovascular Disease in Chronic Kidney Disease. A Clinical Update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney International, 80, 572-586. http://dx.doi.org/10.1038/ki.2011.223
[32]	Pcoits-Filho, R., Bucharles, S. and Barberato, S.H. (2012) Diastolic Heart Failure in Dialysis Patients: Mechanisms, Diagnostic Approach, and Treatment. Seminars in Dialysis, 25, 35-41. http://dx.doi.org/10.1111/j.1525-139X.2011.01011.x
[33]	Quiroga, B., Villaberde, M., Abad, S., Vega, A., Reque, J. and Lopez-Gomez, J.M. (2013) Diastolic Dysfunction and High Levels of New Cardiac Biomarkers as Risk Factors for Cardiovascular Events and Mortality in Hemodialysis Patients. Blood Purification, 36, 98-106. http://dx.doi.org/10.1159/000354080