Evaluation of echocardiographic abnormalities and associated factors in 100 hemodialysis patients

Abstract

Systematic assessment of cardiac remodeling in hemodialysis (HD) patients is essential for cardiovascular risk stratification. Echocardiography is a widely available tool for evaluating structural and functional cardiac abnormalities. We investigated associations between clinical and dialysis-related parameters and echocardiographic abnormalities among patients receiving chronic HD at the Dezful Nephrology Center in southwestern Iran. In this cross-sectional study, 160 adults undergoing chronic HD were screened and 100 met the predefined inclusion and exclusion criteria. All participants underwent transthoracic echocardiography. Associations between echocardiographic abnormalities and age, sex, diabetes, hypertension, body mass index (BMI), dyslipidemia, coronary and non-coronary vascular disease, dialysis access type, dialysis vintage, anemia, plasma lipid concentrations, and resting heart rate were evaluated Bivariate analyses were followed by multivariable logistic regression for prespecified binary echocardiographic outcomes. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. A two-sided P -value < 0.05 was considered statistically significant. Echocardiographic abnormalities were present in 86% of patients. After multivariable adjustment, hypertension (aOR 2.80, 95% CI 1.30–6.00), coronary artery disease (aOR 6.10, 95% CI 1.90–19.60), non-coronary vascular disease (aOR 4.20, 95% CI 1.30–13.60), and lower plasma triglycerides (aOR 0.99 per mg/dL, 95% CI 0.98–0.995) were independently associated with left ventricular systolic dysfunction. Diabetes was associated with diastolic dysfunction (aOR 2.60, 95% CI 1.10–6.20) and moderate-to-severe mitral or tricuspid regurgitation (aOR 2.40, 95% CI 1.00–5.70). Dialysis access type and non-coronary vascular disease were linked to left ventricular hypertrophy. Lower plasma triglycerides, higher resting heart rate, and non-coronary vascular disease were associated with right ventricular abnormality. Lower BMI and lower plasma triglycerides were associated with a higher aortic index. Traditional risk factors together with dialysis-related parameters, particularly low serum triglycerides, low BMI, and arteriovenous fistula access, showed independent associations with specific echocardiographic phenotypes. Echocardiographic abnormalities are highly prevalent in this HD cohort and independently associated with both traditional cardiovascular risk factors and selected dialysis-related parameters, including low plasma triglycerides, low BMI, and the presence of arteriovenous fistula. These findings support closer clinical attention to these variables for cardiac risk stratification in hemodialysis patients. Given the cross-sectional design and modest sample size, the results represent associations rather than causal effects. Not applicable.