Maggio Giugno 2024 - Editorial

Prevalence and Risk Factors of Heart Failure with Preserved Ejection Fraction in Middle-Aged Maintenance Haemodialysis Patients on a Twice-Weekly Schedule: Experience from a Single Indian Centre


Background. Data on the prevalence of cardiac failure with preserved ejection in the haemodialysis population, which impacts treatment strategy, mortality, and morbidity, are scarce.
Aims and Objectives. 

  • Estimate the prevalence of heart failure with preserved ejection fraction (HFpEF) in haemodialysis patients
  • Classify cardiac failure and ascertain the risk factors influencing HFpEF in haemodialysis patients.

Methods. All consenting individuals on haemodialysis over 18 years of age were included. Lung ultrasound was performed as per the LUST study protocol, and the labs were documented. Echocardiographic parameters were measured using two-dimensional (2D ECHO).
Results. A total of 102 patients consented to participate in the study, which included 63 males (61.8%) and 39 females (38.2%). The mean patient age was 53 ± 13.1 years. The dialysis vintage of the participants was 38.92 ± 6.947 months. 47 (46.1%) patients had diabetes and 88 (80.4%) had hypertension. ECG findings included sinus rhythm (51/102, 50%), sinus tachycardia (22/102, 21.6%), ST-T wave abnormalities (18/102, 17.6%), and atrial fibrillation (11/102, 10.8%). Heart failure with preserved ejection fraction (HFpEF) was present in 44/102 (43.14%), heart failure with mid-range EF in 14/102 (13.72%), and heart failure with reduced EF in 13/102 (12.7%) patients. The ejection fraction was positively associated with haemoglobin (r = 0.23; p = 0.044), and calcium levels (r = 0.25; p =0 .03). E/lateral e′ ratio was positively correlated with NT pro-BNP (r = 0.63; p < 0.001), systolic blood pressure (r = 0.44; p = 0.003) and age (r = 0.353; p = 0.003) and negatively correlated with transferrin saturation (r = -0.353; p = 0.027) and diastolic blood pressure (r = -0.31; p = 0.040). Binary logistic regression analysis revealed that the odds of diastolic dysfunction increased by 2.3 times with each unit increase of creatinine, and diabetics have 7.66 times higher risk for diastolic dysfunction. Binary logistic regression involving ejection fraction (EF) and all laboratory and clinical parameters revealed odds of HFpEF increased by 1.93 times with each unit increase in age, odds of HFpEF increases by 1.53 times with each unit increase in phosphorous and odds of HFpEF increased by 1.1 times with a unit increase of systolic blood pressure. Conclusion. HFpEF is the predominant form of heart failure in haemodialysis patients. Haemoglobin and calcium were positively associated with ejection fraction. Advancing age, elevated creatinine and diabetes mellitus levels are independent predictors of diastolic dysfunction in haemodialysis patients.

Keywords. HFpEF, E/ Lateral e, E/A ratio, 2D ECHO, hemodialysis, cardiac failure

Introduction and Background

Cardiac failure is a predominant cardiovascular complication in the chronic kidney disease (CKD) population and it increases in prevalence with advancing renal failure [1]. The presence of cardiac failure in the dialysis population is predictive of short and long-term mortality in haemodialysis [2, 3]. The most prominent cause of mortality among haemodialysis patients is cardiovascular disease, which accounts for nearly 44% of the overall mortality [4].

Heart failure is classified into three major types: heart failure with reduced ejection fraction (HFrEF), mid-range ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF). HFpEF is a clinical syndrome characterized by symptoms and signs of cardiac failure, presence of diastolic dysfunction (DD), and near-normal or normal left ventricular (LV) systolic function (EF≥50%) [5]. Diastolic dysfunction can manifest as impaired left ventricle relaxation or increased filling pressure. 

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