Do Echocardiographic Parameters Predict Mortality in Patients With End-Stage Renal Disease?

Stallworthy, Elizabeth J; Pilmore, Helen; Webster, Mark; Sidhu, Karishma; Curry, Elizabeth; Brown, Pieta; Scaria, Anish

doi:10.1097/tp.0b013e31828dbbbe

Cited by 35 publications

(29 citation statements)

References 38 publications

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“…In a retrospective study, Stallworthy et al . [16] reviewed echocardiographic data of patients in renal transplantation waiting list and reported that pulmonary hypertension and/or right ventricular function was associated with an increased risk of all-cause mortality. Left ventricular dysfunction and regional wall motion abnormalities were among the independent predictors of survival in this study.…”

Section: Discussionmentioning

confidence: 99%

High hemodialysis vascular access flow and impaired right ventricular function in chronic hemodialysis patients

et al. 2016

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There are limited data showing right ventricular preload increase due to high-flow arteriovenous fistulas (AVFs). This cross-sectional study investigated whether high AVF flow had an impact on right ventricular function in patients undergoing hemodialysis. Sixty-four patients aged between 18 and 85 years who were on routine hemodialysis with >2 hemodialysis sessions per week for at least 3 months via an AVF were studied. Patients with inadequate flow fistulas, severe chronic obstructive pulmonary disease, history of pulmonary embolism, primary pulmonary hypertension, severe mitral, aortic or pulmonary regurgitation, and/or stenosis were excluded. After an initial evaluation, 44 patients (mean age: 58.50 ± 16.84, male:female = 23:21) were considered eligible. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE). AVF blood flow was measured with duplex ultrasound. There were 15 patients (34.1%) with a TAPSE of <16 mm. AVF blood flow was significantly higher in patients with impaired versus normal right ventricular function (1631.53 ± 738.17 vs. 1060.55 ± 539.92 min/ml, respectively, P = 0.003). Low left ventricular ejection fraction (odds ratio [OR]: 1.15, 95% confidence intervals [CI]: 1.007-1.334, P = 0.04), high interventricular septum thickness (OR: 1.64, 95% CI: 1.104–2.464, P = 0.01), and high AVF blood flow (OR: 1.00, 95% CI: 1.000-1.003, P = 0.03) were independent predictors of impaired right ventricular function. In addition to known risk factors that predominantly increase right ventricular afterload, excessive AVF blood flow was found to be independently associated with impaired right ventricular function, possibly by increasing right ventricular preload.

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Section: Discussionmentioning

confidence: 99%

High hemodialysis vascular access flow and impaired right ventricular function in chronic hemodialysis patients

et al. 2016

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“…Accordingly, other cohort studies of patients with only mildly to moderately reduced LVF did not find an association of this parameter with mortality (17). It is noteworthy that a recent retrospective study by Stallworthy et al (18) showed an association of LVF with mortality. However, Stallworthy et al (18) had no measurements of LA2D, and therefore, this parameter was not included in their analysis.…”

Section: Discussionmentioning

confidence: 93%

“…It is noteworthy that a recent retrospective study by Stallworthy et al (18) showed an association of LVF with mortality. However, Stallworthy et al (18) had no measurements of LA2D, and therefore, this parameter was not included in their analysis.…”

Section: Discussionmentioning

confidence: 95%

Left Atrial Diameter and Survival among Renal Allograft Recipients

Kainz

Goliasch

Wiesbauer

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Sequential echocardiography is routinely performed in patients with ESRD listed for transplantation. The benefit of this labor-and time-intensive measure, however, remains unclear. Thus, this study elucidated the various obtained routine echocardiography parameters that best predicted mortality and graft survival after renal transplantation.Design, setting, participants, & measurements This study investigated 553 first renal transplant recipients listed in the Austrian Dialysis and Transplant Registry between 1992 and 2011 who had echocardiographic analysis at transplantation and survived at least 1 year. Cox proportional hazards models with the purposeful selection algorithms for covariables were used to identify predictors of mortality and graft loss. A Fine and Gray model was used to evaluate cause-specific death.Results During a median follow-up of 7.14 years, 81 patients died, and 59 patients experienced graft loss after the first year. The Kaplan-Meier analysis showed that 85% of patients with a left atrial diameter below the median of 53 mm were alive 10 years after transplantation, whereas only 70% of those patients with a left atrial diameter equal to or above the median had survived (P,0.001). In the multivariable model, left atrial diameter (per millimeter) independently predicted overall mortality (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.08; P,0.001) and cause-specific cardiac death (hazard ratio, 1.04; 95% confidence interval, 1.00 to 1.08; P=0.04). Functional graft loss was predicted by the right atrial diameter (hazard ratio, 1.04; 95% confidence interval, 1.02 to 1.07; P=0.001). ConclusionThe left atrial diameter determined at transplantation predicted overall and cardiac mortality. Patients with widely enlarged left atria exhibit a considerably reduced life expectancy. It remains to be determined, however, whether renal transplantation is futile in these patients.

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“…At the same time there are numerous observations of improvement in PHT along with other echocardiographic parameters after renal transplantation [1,12,25,26]. This has led many to propose that PHT can be used as an indication for expeditious renal transplantation [12,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…A clear cutoff of severity of pulmonary artery pressures beyond which mortality risk increases is not well defined. It has been suggested that patients with mild to moderate PHT may be considered for expedited transplantation to prevent the PHT from worsening and potentially improve it [1,12,25,26] and severe PHT may be treated before transplantation to improve patient and graft outcomes.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary hypertension in renal transplant candidates: A systematic review and meta-analysis of the available evidence and a proposed algorithm for pre-transplant management

Moza¹,

Khan²,

Parashar³

et al. 2017

Trends in Transplant

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Background: Pulmonary hypertension (PHT) is common in patients with end stage renal disease (ESRD). Moderate to severe PHT is a strong independent predictor of mortality in hemodialysis (HD) patients, and in those undergoing noncardiac surgery. The studies which have evaluated the association of PHT with renal transplant outcomes have shown conflicting results. We performed a systematic review and meta-analysis of the current available evidence examining the effect of existing PHT on relevant clinical outcomes following renal transplantation.

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Do Echocardiographic Parameters Predict Mortality in Patients With End-Stage Renal Disease?

Cited by 35 publications

References 38 publications

High hemodialysis vascular access flow and impaired right ventricular function in chronic hemodialysis patients

High hemodialysis vascular access flow and impaired right ventricular function in chronic hemodialysis patients

Left Atrial Diameter and Survival among Renal Allograft Recipients

Pulmonary hypertension in renal transplant candidates: A systematic review and meta-analysis of the available evidence and a proposed algorithm for pre-transplant management

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