Echocardiography Criteria for Structural Heart Disease in Patients with End-Stage Renal Disease Initiating Hemodialysis

La Tonya J. Hickson, Sara M. Negrotto, MacAulay Onuigbo, Christopher G. Scott, Andrew D. Rule, Suzanne M. Norby, Robert C. Albright, Edward T. Casey, John J. Dillon, Patricia A. Pellikka, Sorin V. Pislaru, Patricia J.M. Best, Hector R. Villarraga, Grace Lin, Amy W. Williams, Vuyisile T. Nkomo

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Background Cardiovascular disease among hemodialysis (HD) patients is linked to poor outcomes. The Acute Dialysis Quality Initiative Workgroup proposed echocardiographic (ECHO) criteria for structural heart disease (SHD) in dialysis patients. The association of SHD with important patient outcomes is not well defined. Objectives This study sought to determine prevalence of ECHO-determined SHD and its association with survival among incident HD patients. Methods We analyzed patients who began chronic HD from 2001 to 2013 who underwent ECHO ≤1 month prior to or ≤3 months following initiation of HD (n = 654). Results Mean patient age was 66 ± 16 years, and 60% of patients were male. ECHO findings that met 1 or more and ≥3 of the new criteria were discovered in 87% and 54% of patients, respectively. Over a median of 2.4 years, 415 patients died: 108 (26%) died within 6 months. Five-year mortality was 62%. Age- A nd sex-adjusted structural heart disease variables associated with death were left ventricular ejection fraction (LVEF) ≤45% (hazard ratio [HR]: 1.48; confidence interval [CI]: 1.20 to 1.83) and right ventricular (RV) systolic dysfunction (HR: 1.68; CI: 1.35 to 2.07). An additive of higher death risk included LVEF ≤45% and RV systolic dysfunction rather than neither (HR: 2.04; CI: 1.57 to 2.67; p = 0.53 for test for interaction). Following adjustment for age, sex, race, diabetic kidney disease, and dialysis access, RV dysfunction was independently associated with death (HR: 1.66; CI 1.34 to 2.06; p < 0.001). Conclusions SHD was common in our HD study population, and RV systolic dysfunction independently predicted mortality.

Original languageEnglish (US)
Pages (from-to)1173-1182
Number of pages10
JournalJournal of the American College of Cardiology
Issue number10
StatePublished - Mar 15 2016


  • Key Words chronic kidney disease
  • heart failure
  • hemodialysis
  • left ventricle
  • right ventricle
  • structural heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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