Predictive value of echocardiography and its relation to Kt/V and anthropometric parameters in hemodialysis patients

Figures & data

Table 1. Demographic variables, diagnosis, clinical and laboratory data.

Parameter	Value
Age (years)^a	53.3 (12.2)
Dialysis vintage (months)^b	53.0 (24.7–97.7)
Sex (men/women)	58/48
Primary renal diagnosis
Nephrosclerosis (hypertension)	10.4%
Diabetes	4.7%
Glomerulonephritis	17.9%
Polycystic kidney disease	13.2%
Interstitial nephritis	8.5%
Other	22.6%
Unknown	22.6%
Kt/V^a	1.21 (0.22)
MAP (mmHg)^a	97 (9)
Ischemic heart disease	26.4%
Hypervolemic state	40.5%
Laboratory analysis
Hemoglobin (g/l)^a	93.3 (16.0)
Urea (mmol/l)^a	28.0 (4.1)
Creatinine (µmol/l)^a	1047 (203)
Calcium (mmol/l)^a	2.29 (0.20)
Phosphorus (mmol/l)^a	1.85 (0.36)
Albumin (g/l)^a	39.9 (4.7)

Notes: ^aMean (SD); ^bmedian (interquaritle value).

Table 2. Echocardiograph parameters.

Parameter	Mean (SD) or median (interquartile value)	Percentage of deviation from normal values
Peek velocity of tricuspid flow (m/s)^a	0.63 (0.10)	13%
Aortic dimension (cm)^a	3.35 (0.45)	17%
Systolic separation of aortic leaflet (cm)^a	1.88 (0.33)	11%
Aortic peek velocity (m/s)^a	1.50 (0.65)	47%
Peak velocity of pulmonic flow (m/s)^a	1.09 (0.23)	45%
LV diastolic dimension (cm)^a	5.18 (0.75)	22%
LV systolic dimension (cm)^a	3.47 (0.70)	17%
Septal thickness (cm)^a	1.04 (0.22)	25%
Posterior wall thickness (cm)^a	0.95 (0.15)	10%
Left ventricular mass index (g/m^2 bsa)^a	116 (44)	64%
LA dimension (cm)^a	3.72 (0.61)	26%
RV diastolic dimension (cm)^b	2.31 (0.55)	16%
LV end diastolic volume (ml)^b	125 (101–145)	32%
LV end systolic volume (ml)^b	49.0 (34.5–61.0)	38%
Stroke volume (ml)^a	78.2 (27.3)	53%
Cardiac output (l/min)^a	5.66 (1.82)	19%
Ejection fraction (%)^a	60.3 (9.7)	25%
Fractional shortening (%)^a	31.8 (6.7)	33%
Cardiac index (l/min/m^2BSA)^a	3.49 (1.29)	46%
Stroke index (ml/m^2BSA)^a	43.7 (17.9)	55%
Mean velocity of circumf. fiber shortening (Vcf, circ/s)^a	1.33 (0.43)	15%
Acceleration of transmitral flow^b	11.2 (7.5–18.2)	56%
Acceleration time (m/s^2)^b	50.0 (40.0–70.0)	84%
Deceleration of transmitral flow (m/s^2)^b	5.19 (2.23–16.07)	63%
Deceleration time (ms)^a	119 (47)	76%
Flow duration (ms)^a	325 (105)	14%
Velocity time integral of mitral flow (m)^a	0.14 (0.05)	40%
VTI A wave of mitral flow (m)^b	0.06 (0.05–0.09)	18%
Isovolumetric relaxation time (ms)^a	126 (29)	88%
Duration of A wave of mitral flow (ms)^a	126 (39)	28%
E/A^a	0.69 (0.20)	91%

Notes: LV – left ventricular; RV – right ventricular; LA – left atrium; BSA – body surface area.

^aMean (SD), normal distribution (Kolmogorov–Smirnov test); ^bmedian (interquartile value).

Table 3. Anthropometric variables.

Parameter	Men	Women
Body weight (kg)	72.0 (14.0)	58.6 (11.1)
BMI (kg/cm2)	23.6 (4.0)	22.7 (3.7)
Mid-arm circumference (cm)	28.6 (3.9)	26.8 (4.8)
Mid-arm muscle circumference (cm)	24.9 (2.6)	22.3 (3.3)
Triceps skinfold (mm)	11.6 (6.6)	14.2 (6.0)
Percentage of body fat	20.9 (7.8)	28.9 (6.9)

Note: All variables were expressed as mean (SD).

Table 4. Differences between Kt/V subgroups and echocardiograph parameters and between fat percentage subgroups and echocardiograph parameters.

Parameter	Kt/V ≤ 1.2	Kt/V > 1.2	%fat ≤50 pct	%fat >50 pct
Peek velocity of tricuspid flow (m/s)^a	0.62	0.63	0.62	0.63
Aortic dimension (mm)^a	3.48**	3.21**	3.44*	3.26*
Systolic separation of aortic leaflet (cm)^a	1.97**	1.79**	1.83	1.93
Aortic peek velocity (m/s)^a	1.56	1.44	1.61	1.40
Peak velocity of pulmonic flow (m/s)^a	1.14*	1.03*	1.07	1.10
LV diastolic dimension (cm)^a	5.47**	4.83**	5.07	5.28
LV systolic dimension (cm)^a	3.76**	3.13**	3.40	3.54
Septal thickness (cm)^a	1.10**	0.96**	1.00	1.08
Posterior wall thickness (cm)^a	0.98	0.92	0.95	0.95
Left ventricular mass index (g/m^2 bsa)^a	123	109	121	111
LA dimension (cm)^a	3.83*	3.58*	3.72	3.72
RV diastolic dimension (cm)^b	2.22	2.43	2.32	2.30
LV end diastolic volume (ml)^b	149**	112**	127	135
LV end systolic volume (ml)^b	63.2**	40.9**	50.9	54.2
Stroke volume (ml)^a	85.2**	70.2**	76.5	79.8
Cardiac output (l/min)^a	6.03	5.29	5.18*	6.11*
Ejection fraction (%)^a	57.5**	63.5**	60.1	60.6
Fractional shortening (%)^a	30.4*	33.5*	31.9	31.8
Cardiac index (l/min/m^2BSA)^a	3.59	3.37	3.58	3.42
Stroke index (ml/m^2BSA)^a	45.2	42.1	41.5	45.7
Mean velocity of circumf. fiber shortening (Vcf, circ/s)^a	1.21*	1.48*	1.25	1.40
Acceleration of transmitral flow^b	14.4	16.9	15.0	16.0
Acceleration time (m/s^2)b	65.7	57.5	58.7	65.2
Deceleration of transmitral flow (m/s^2)b	38.4	27.1	29.8	36.7
Deceleration time (ms)^a	116	123	126	113
Flow duration (ms)^a	323	329	328	323
Velocity time integral of mitral flow (m)^a	0.14	0.14	0.15	0.13
VTI A wave of mitral flow (m)^b	0.10	0.07	0.06	0.11
Isovolumetric relaxation time (ms)^a	133	119	123	130
Duration of A wave of mitral flow (ms)^a	126	126	127	126
E/A^a	0.71	0.67	0.72	0.66

Notes: LV – left ventricular; RV – right ventricular; LA – left atrium; BSA – body surface area.

^at- test; ^bMann–Whitney test.

*p < 0.05; **p < 0.01; 50 pct – 50 percentile value separately for men and women.

Table 5. Cox proportional hazard model – selected parameters p < 0.10.

Parameter	Hazard ratio (CI)	p
Age	1.04 (1.01–1.07)	<0.01
Nephrosclerosis	2.31 (1.06–5.00)	0.03
Glomerulonephritis	0.43 (0.16–1.10)	0.08
Ischemic heart disease	1.82 (0.96–3.43)	0.06
Kt/V*	0.08 (0.01–0.39)	<0.01
Kt/V – binary (0 values <1.2 other 1)^a	0.37 (0.19–0.73)	<0.01
Kt/V – binary (0 values <1.3 other 1)	0.36 (0.16–0.79)	0.01
Urea	1.08 (1.00–1.17)	0.04
Albumin	0.87 (0.80–0.93)	<0.01
Aortic peek velocity	2.88 (1.70–4.78)	<0.01
Peak velocity of pulmonic flow^b	10.54 (1.53–72.29)	0.01
LV diastolic dimension	1.55 (1.03–2.34)	0.03
LV systolic dimension^c	1.67 (1.06–2.61)	0.02
LV mass index^a	1.00 (1.00–1.01)	0.02
LA dimension^a	1.78 (1.12–2.83)	0.01
LA dimension - binary (0 values < 4 cm other 1)	2.94 (1.52–5.69)	<0.01
End diastolic volume LV^d	1.00 (1.00–1.01)	0.01
End systolic volume LV^d	1.01 (1.00–1.02)	<0.01
Ejection fraction	0.97 (0.94–1.00)	0.07
VTI A wave of mitral flow^b	803.42 (5.95–108397.70)	<0.01

Notes: Univariate test of parameters, all-cause mortality in the cohort.

^aExcluded – no proportional; ^bExcluded – missing values; ^cExcluded – collinear with ejection fraction; ^dExcluded – collinear with LV systolic dimension; Hazard ratio – Exp (B), CI – 95% confidence interval of Exp (B), p – significance of coefficient.

Table 6. Predictors of all-cause mortality in the cohort.

Parameter	Hazard ratio (CI)	p
Age	1.07 (1.03–1.12)	<0.01
Albumin	0.88 (0.79–0.97)	0.01
LA dimension – binary  (0 values <4 cm other 1)	3.76 (1.56–9.03)	<0.01

Note: Hazard ratio – Exp (B), CI – 95% confidence interval of Exp (B), p – significance of coefficient. Multivariate Cox proportional hazard model.

Madore F. Uremia-related metabolic cardiac risk factors in chronic kidney disease. Semin Dial. 2003;16:148–156

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