Independent Association of Overhydration with All-Cause and Cardiovascular Mortality Adjusted for Global Left Ventricular Longitudinal Systolic Strain and E/E’ Ratio in Maintenance Hemodialysis Patients

Abstract

Background/Aims: Fluid overload is common and associated with morbidity and mortality in patients with end-stage renal disease. The relationship between fluid overload and cardiac function is complex, and whether fluid overload is associated with adverse outcomes in patients undergoing hemodialysis (HD) independently of systolic and diastolic function of the left ventricle (LV) remains unclear. Methods: The present study aimed to investigate the relationship between overhydration and all-cause and cardiovascular (CV) mortality after adjusting for LV function in 178 maintenance HD patients. The relative hydration status (overhydration/ extracellular water, ∆HS) was measured using a body composition monitor, and then used to assess the fluid status. A ∆HS ≥7% was defined as fluid overload. Global left ventricular longitudinal systolic strain (GLS), and the early filling and early diastolic mitral annular velocity (E/E’) ratio were assessed using speckle-tracking and tissue Doppler echocardiography. Results: During a mean follow-up period of 2.7 years, 24 patients died, including 11 CV deaths. An increased ∆HS was significantly associated with all-cause and CV mortality in the univariate analysis. This prognostic significance remains after multivariate adjusting for GLS and E/E’ ratio for all-cause (HR, 1.123; 95% CI, 1.063–1.186; p-value < 0.001) and CV (HR, 1.088; 95% CI, 1.005–1.178; p-value =0.037) mortality. Moreover, ∆HS significantly improved the prognostic value beyond conventional clinical and echocardiographic parameters. Conclusion: A higher ∆HS was independently associated with increased all-cause and CV mortality after adjusting for systolic and diastolic function of the LV. This suggests that ∆HS may be a relevant target for improving outcomes in maintenance HD patients.

Effect of bioimpedance-defined overhydration parameters on mortality and cardiovascular events in patients undergoing dialysis: a systematic review and meta-analysis

“…Finally, 55 studies were included. 5 , 7 , 13 – 65 A flow diagram of the complete search strategy, article screening, and exclusion and inclusion processes in this review are shown in Figure 1 .…”

Ratio of Early Mitral Inflow Velocity to the Global Diastolic Strain Rate and Global Left Ventricular Longitudinal Systolic Strain Predict Overall Mortality and Major Adverse Cardiovascular Events in Hemodialysis Patients

“…An important finding of this study highlights that the E/E'sr ratio is a novel risk factor for overall mortality, CV mortality, and MACE in patients undergoing HD. At present, the E/E' ratio is a recommended modality to assess LV diastolic function [8, 28] and associated with mortality in HD patients [29] but it still has some drawbacks such as angle dependency and risk of errors with angulations > 20°. The E'sr obtained by STE from the whole left ventricle could overcome these limitations and more accurately represent global LV relaxation.…”

Association between Reduced Serum Zinc and Diastolic Dysfunction in Maintenance Hemodialysis Patients

“…Indicators of diastolic dysfunction, such as E/e’ ratio and LAVI, have been shown to independently predict ominous prognosis in HD patients [ 24 , 25 ]. The risk factors and their involvement in the pathophysiology of diastolic dysfunction in HD patient populations are complex.…”