An index of left ventricular diastolic dysfunction in patients starting peritoneal dialysis might indicate mortality and peritoneal dialysis discontinuation.

BACKGROUND

The E/e' ratio is recognized as a reliable and sensitive echocardiographic marker of left ventricular diastolic dysfunction (LVDD). Increased E/e' is known to be associated with mortality and cardiovascular events in kidney failure patients undergoing maintenance replacement therapy. To elucidate the prognostic significance of E/e' in patients starting peritoneal dialysis (PD), we investigated the relations between baseline E/e' after PD initiation and death or PD discontinuation.

METHODS

Data were collected retrospectively from patients with the E/e' ratio evaluated early after PD initiation during August 2008 through December 2023. We investigated the association between the average of septal and lateral E/e' (E/e' Avg) and a composite outcome comprising mortality and PD discontinuation within 8 years after PD initiation.

RESULTS

This study included 74 incident PD patients with median age of 64 years (74% male). The median value of E/e' Avg was 9.4 at the median time of 3.3 months after PD initiation. Based on the cut-off value inferred from receiver operating characteristic analysis, patients were divided into two groups: patients with E/e' Avg ≤ 9.0 and with E/e' Avg > 9.0. Kaplan-Meier analysis indicated the 8-year survival and PD continuation rates as significantly lower for the E/e' Avg > 9.0 group than for the E/e' Avg ≤ 9.0 group (p = .0019). Cox proportional hazards analyses showed E/e' Avg as independently associated with the composite outcome (hazard ratio 1.17, 95% confidence interval 1.07-1.28).

CONCLUSION

Increased E/e' Avg early after PD initiation is associated positively with 8-year mortality and PD discontinuation.