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Kidney Week

Abstract: TH-PO272

Left Ventricular Global Longitudinal Strain in Stable Stage 5 CKD Patients with Preserved Ejection Fraction Predicts Cardiovascular Events and Mortality After Dialysis Commencement

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yu, Chih-Hen, National Cheng Kung University College of Medicine, Tainan, Taiwan
  • Wenhuang, Li, National Cheng Kung University College of Medicine, Tainan, Taiwan
  • Liu, Yen-wen, National Cheng Kung University College of Medicine, Tainan, Taiwan
  • Sung, Junne-Ming, National Cheng Kung University College of Medicine, Tainan, Taiwan
Background

Early detection of subclinical cardiac dysfunction offers opportunity of timely intervention, especially before vulnerable transition from advanced CKD to ESKD. We previously found absolute left ventricular global longitudinal strain (GLS) <15% is predictive to mortality in dialysis patients with preserved ejection fraction (EF), while it's still inconclusive whether the systolic function evaluated by GLS before hemodialysis commencement (HDC) is applicable to predict post-dialysis outcome in clincial stable CKD5 patients.

Methods

In this longitudinal prospective observation across HDC, we aimed to predict the post-dialysis cardiovascular outcome with pre-dialysis GLS. The CKD5 patients who had long-term HDC before 2020 were enrolled to post-dialysis outcome follow-up. Inclusions were EF>50% and eligible GLS within 2 years before HDC; main exclusion was frequent admission. The primary outcomes were post-dialysis major adverse cardiovascular cerebral events(MACCE), and secondary outcome was all-cause mortality(ACM).

Results

201 among 242 stable CKD5 patients reached HDC, and 108 with eligible GLS were enrolled. Median duration from examination to HDC was 5.39 months. Median follow-up was 1458 days. GLS<15% is independent predictor of MACCE (HR 2.34[1.11-4.91]p=.025*) and ACM(HR 2.97[1.18-7.49]p=.021*). GLS as continuous variable is independent predictor of MACCE(HR 0.90[0.82-1.00]p=.040*) and ACM(HR 0.84[0.73-0.95]p=.007**). The incremental diagnostic values contributed from GLS<15%(p=.025*) or GLS(p=.042*) were significant in nested Cox models but LVEF (Figure).

Conclusion

LV subclinical systolic dysfunction, assessed by GLS<15% within previous 2 years before HDC, predictedpost-dialysis MACCE and ACM in clinically stable patients having their HDC.

GLS and GLS<15% increase predicting value of Cox models of MACCE; colums represent chi-square value in -2 log likelihood test