Right Ventricular Dysfunction May Hold Key to Survival in Hemodialysis Patients

Structural heart disease variables associated with death included left ventricular ejection fraction ≤45% and right ventricular systolic dysfunction.

Right ventricular (RV) dysfunction may have important prognostic implications for hemodialysis patients, according to research published in the Journal of the American College of Cardiology.

Researchers sought to determine the prevalence of structural heart disease, as identified by echocardiography, in hemodialysis patients.

Structural heart disease was common among the study population which included 654 patients (mean age: 66 ± 16 years; 60% male) within the Mayo Clinic Dialysis Services network in southeastern Minnesota, southwestern Wisconsin, and northern Iowa. Patients began chronic outpatient hemodialysis between 2001 and 2013, and echocardiography was performed at least 1 month prior to or at least 3 months after treatment began.

The study’s primary outcome was all-cause mortality. Causes of death included sudden cardiac arrest (29%), dialysis withdrawal (25%), other causes (10%), sepsis (7%), trauma (0.2%), and unknown causes (28%). The 5-year mortality rate was 62%.

Structural heart disease was defined according to ADQI XI Workgroup proposed criteria, with the exception of the LV regional wall motion abnormalities (RWMA). Instead, researchers explained, “the 16-segment model was used for RWMA assessment, and any RWMA was included (instead of >10% of the myocardium); and [RV] systolic dysfunction included semiquantitative assessment.” 

Structural heart disease variables associated with death, adjusted for age and sex, included left ventricular ejection fraction ≤45% (hazard ratio [HR]: 1.48; 95% confidence interval [CI]: 1.20-1.83) and RV systolic dysfunction (HR: 1.68; 95% CI: 1.35-2.07). RV dysfunction was independently associated with death after adjustment for age, sex, race, diabetic kidney disease, and dialysis access (HR: 1:66; CI: 1.34-2.06; P<.001).

Patients without echocardiograms had fewer comorbidities, including coronary artery disease (48% vs 56%, respectively; P=.003), heart failure (36% vs 56%; P<.001), and Charlson score ≥8 (45% vs 52%; P=.02), but were more likely to have arteriovenous fistula or graft dialysis access present at their first treatment (39% vs 20%respectively; P<.001).

“Diastolic dysfunction of grade 2 or higher was not independently associated with excess mortality in the age- and sex-adjusted analyses of our entire study cohort,” researchers noted. “However, an association with diastolic dysfunction and mortality was seen in patients who initiated dialysis before an [echocardiogram] was performed.”

“Additional research is needed to understand the prevalence of SHD [structural heart disease] and indentify predictors of early mortality in patients who start dialysis,” they concluded.


Hickson LJ, Negrotto SM, Onuigbo M, et al. Echocardiography criteria for structural heart disease in patients with end-stage renal disease initiating hemodialysis. J Am Coll Cardiol. 2016;67(10): 1173-1182. doi:10.1016./j.jacc.2015.12.052.