Hospitalization rate and outcomes in patients with left ventricular dysfunction receiving hemodialysis

Figures & data

Table 1 General characteristics of patients according to their ejection fractions (EFs)

Characteristics	EF <40% (N=40)	EF =40%–49% (N=36)	EF =50%–100% (N=257)	P-value
Age
Mean [SD]	61.08 [16.1]	60.9 [13.9]	53.43 [16.8]	0.002
Median [IQR]	61 [18]	63 [12]	55 [22]
Gender
Males	26 (65)	24 (69)	126 (49)	0.025
Females	14 (35)	11 (31)	131 (51)
Comorbidities,a N (%)	37 (92.5)	31 (86.1)	177 (68.9)	<0.001
Diabetes mellitus, N (%)	28 (70)	19 (52.8)	79 (30.7)	<0.001
Hypertension, N (%)	35 (87.5)	29 (80.6)	163 (63.4)	0.002
Dyslipidemia, N (%)	5 (12.5)	1 (2.8)	13 (5.1)	0.122
Ischemic heart disease, N (%)	16 (40)	11 (30.6)	20 (7.8)	<0.001

Note:

a Comorbidities = hypertension, diabetes, ischemic heart disease, and dyslipidemia.

Table 2 Hospitalization rates and outcomes of patients according to their ejection fractions (EFs)

Parameters	EF <40% (N=40)	EF =40%–49% (N=36)	EF = 50%–100% (N=257)	P-value
Number of admissions per 5 years
Median [SD]	6.4 [12.1]	5.5 [7.5]	4.5 [8.6]	0.409
Median [IQR]	2.5 [7]	2 [6]	2 [5]
Minimum–maximum	0–69	0–27	0–86
Average length of stay per admission (days)
Mean [SD]	5.05 [5.5]	13.8 [20.3]	6.8 [13.1]	0.007
Median [IQR]	4 [8]	7 [8]	5 [7]
Minimum–maximum	0–30	0–90	0–180
Intensive care unit admission, N (%)	23 (57.5)	19 (52.8)	94 (36.6)	0.013
Death, N (%)	20 (50.0)	16 (44.4)	68 (26.5)	0.002
Time to death in months
Mean [SD]	45.8 [16]	44 [16.5]	46 [13]	0.852
Median [IQR]	49	51	50

Table 3 Echocardiographic parameters before starting hemodialysis among the three groups

Parameters	EF <40% (N=40)	EF =40%–49% (N=36)	EF = 50%–100% (N=257)	P-value
Left atrium size
Mean [SD]	4.5 [0.8]	4.3 [0.8]	3.9 [0.7]	<0.001
Median	5	4	4
Left ventricle size
Mean [SD]	4.8 [0.8]	4.0 [0.6]	3.6 [0.6]	<0.001
Median	5	4	3
Fractional shortening
Mean [SD]	16.7 [4.7]	25.0 [6.3]	34.2 [5.0]	<0.001
Median	16.5	23	34

Abbreviation: EF, ejection fraction.

Table 4 Characteristics of echocardiographic parameters before the initiation of hemodialysis according to the 5-year mortality

Parameters	Died (N=104)	Survived (N=229)	P-value
Ejection fraction
Mean [SD]	50.7 [15.7]	57 [12.3]	<0.001
Median	55	60
Left atrium size
Mean [SD]	4 [0.7]	4 [0.7]	0.394
Median	4	4
Left ventricle size
Mean [SD]	3.8 [0.9]	3.6 [0.8]	0.07
Median	4	3
Fractional shortening
Mean [SD]	28.8 [8.3]	31 [8.2]	0.047
Median	31	32

Table 5 Logistic regression and OR results for mortality

Variables	P-value	OR (95% CI)
Age (years)	0.027	1.035 (1.004–1.068)
Gender	0.401	1.461 (0.603–3.536)
Comorbidities	0.898	1.148 (0.138–9.546)
Hypertension	0.349	0.423 (0.070–2.562)
Ischemic heart disease	0.923	0.946 (0.307–2.917)
Diabetes mellitus	0.126	2.270 (0.795–6.482)
Dyslipidemia	0.322	2.290 (0.444–11.801)
Body mass index	0.485	0.978 (0.918–1.041)
Number of admissions	0.446	1.024 (0.964–1.088)
Average length of admission in days	0.231	0.971 (0.926–1.019)
Intensive care unit	<0.001	15.983 (6.057–42.175)
Left atrium size	0.797	1.089 (0.569–2.084)
Left ventricle size	0.797	0.907 (0.430–1.912)
Fractional shortening	0.228	1.073 (0.957–1.204)
Ejection fraction	0.148	0.952 (0.890–1.018)

Figure 1 Kaplan–Meier survival analysis for patients according to their EF classification prior to enrolment in the study.

Abbreviation: EF, ejection fraction.

Table 6 Kaplan–Meier survival data

EF			Time		Status estimate		Cumulative proportion surviving at the time		No of cumulative events	No of remaining cases
							Estimate	Standard error
EF <40%	1	11		Died		0.950		0.049	1	19
	2	15		Died		0.0		0.0	2	18
	3	15		Died		0.850		0.080	3	17
	4	43		Died		0.800		0.089	4	16
	5	44		Died		0.0		0.0	5	15
	6	44		Died		0.700		0.102	6	14
	7	46		Died		0.0		0.0	7	13
	8	46		Died		0.600		0.110	8	12
	9	47		Died		0.550		0.111	9	11
	10	48		Died		0.500		0.112	10	10
	11	50		Died		0.0		0.0	11	9
	12	50		Died		0.0		0.0	12	8
	13	50		Died		0.350		0.107	13	7
	14	52		Died		0.0		0.0	14	6
	15	52		Died		0.250		0.097	15	5
	16	55		Died		0.0		0.0	16	4
	17	55		Died		0.0		0.0	17	3
	18	55		Died		0.0		0.0	18	2
	19	55		Died		0.050		0.049	19	1
	20	84		Died		0.000		0.000	20	0
EF =40%–49%	1	4		Died		0.938		0.061	1	15
	2	8		Died		0.875		0.083	2	14
	3	32		Died		0.813		0.098	3	13
	4	40		Died		0.750		0.108	4	12
	5	43		Died		0.688		0.116	5	11
	6	45		Died		0.0		0.0	6	10
	7	45		Died		0.563		0.124	7	9
	8	51		Died		0.500		0.125	8	8
	9	52		Died		0.0		0.0	9	7
	10	52		Died		0.375		0.121	10	6
	11	54		Died		0.313		0.116	11	5
	12	55		Died		0.0		0.0	12	4
	13	55		Died		0.0		0.0	13	3
	14	55		Died		0.125		0.083	14	2
	15	56		Died		0.063		0.061	15	1
	16	59		Died		0.000		0.000	16	0
EF >49%	1	0		0.00		0.0		0.0	0	66
	2	7		Died		0.0		0.0	1	65
	3	7		Died		0.970		0.021	2	64
	4	18		Died		0.955		0.026	3	63
	5	23		Died		0.939		0.029	4	62
	6	24		Died		0.924		0.033	5	61
	7	25		Died		0.0		0.0	6	60
	8	25		Died		0.894		0.038	7	59
	9	28		Died		0.879		0.040	8	58
	10	38		Died		0.864		0.042	9	57
	11	41		Died		0.848		0.044	10	56
	12	43		Died		0.0		0.0	11	55
	13	43		Died		0.818		0.047	12	54
	14	44		Died		0.0		0.0	13	53
	15	44		Died		0.0		0.0	14	52
	16	44		Died		0.0		0.0	15	51
	17	44		Died		0.0		0.0	16	50
	18	44		Died		0.742		0.054	17	49
	20	45		Died		0.0		0.0	19	47
	21	45		Died		0.697		0.057	20	46
	22	46		Died		0.682		0.057	21	45
	23	47		Died		0.0		0.0	22	44
	24	47		Died		0.0		0.0	23	43
	25	47		Died		0.0		0.0	24	42
	26	47		Died		0.0		0.0	25	41
	27	47		Died		0.606		0.060	26	40
	28	48		Died		0.0		0.0	27	39
	29	48		Died		0.0		0.0	28	38
	30	48		Died		0.561		0.061	29	37
	31	49		Died		0.0		0.0	30	36
	32	49		Died		0.530		0.061	31	35
	33	50		Died		0.0		0.0	32	34
	34	50		Died		0.0		0.0	33	33
	35	50		Died		0.0		0.0	34	32
	36	50		Died		0.0		0.0	35	31
	37	50		Died		0.455		0.061	36	30
	38	51		Died		0.0		0.0	37	29
	39	51		Died		0.0		0.0	38	28
	40	51		Died		0.0		0.0	39	27
	41	51		Died		0.0		0.0	40	26
	42	51		Died		0.0		0.0	41	25
	43	51		Died		0.364		0.059	42	24
	44	52		Died		0.0		0.0	43	23
	45	52		Died		0.0		0.0	44	22
	46	52		Died		0.0		0.0	45	21
	47	52		Died		0.303		0.057	46	20
	48	53		Died		0.0		0.0	47	19
	49	53		Died		0.273		0.055	48	18
	50	54		Died		0.0		0.0	49	17
	51	54		Died		0.242		0.053	50	16
	52	55		Died		0.0		0.0	51	15
	53	55		Died		0.212		0.050	52	14
	54	56		Died		0.197		0.049	53	13
	55	57		Died		0.0		0.0	54	12
	56	57		Died		0.0		0.0	55	11
	57	57		Died		0.152		0.044	56	10
	58	58		Died		0.0		0.0	57	9
	59	58		Died		0.0		0.0	58	8
	60	58		Died		0.106		0.038	59	7
	61	59		Died		0.0		0.0	60	6
	62	59		Died		0.076		0.033	61	5
	63	60		Died		0.0		0.0	62	4
	64	60		Died		0.0		0.0	63	3
	65	60		Died		0.0		0.0	64	2
66	60		Died		0.0		0.0	65	1
67	60		Died		0.000		0.000	66	0

Abbreviation: EF, ejection fraction.

Table 7 Linear regression for number of admissions

Coefficients
Model	Unstandardized coefficients		Standardized coefficients	t	P-value	95% CI for B
	B	Standard error	β			Lower bound	Upper bound
Ejection fraction	−0.025	0.087	−0.047	−0.281	0.779	−0.0197	0.148
Age	−0.019	0.035	−0.048	−0.534	0.594	−0.088	0.051
Gender	−1.137	1.067	−0.082	−1.066	0.288	−3.244	0.969
Comorbidities	−1.022	2.606	−0.055	−0.392	0.695	−6.166	4.121
Hypertension	0.347	2.313	0.021	0.150	0.881	−4.218	4.912
Ischemic heart disease	1.107	1.484	0.064	0.746	0.457	−1.821	4.035
Diabetes mellitus	1.822	1.302	0.130	1.400	0.163	−0.747	4.392
Dyslipidemia	3.671	2.234	0.124	1.643	0.102	−0.739	8.08
Body mass index	−0.081	0.076	−0.081	−1.058	0.291	−0.231	0.070
Average length of admission in days	0.018	0.069	0.020	0.257	0.798	−0.118	0.154
Intensive care unit	1.754	1.147	0.125	1.529	0.128	−0.510	4.018
Left atrium size	1.106	0.782	0.118	1.413	0.159	−0.438	2.650
Left ventricle size	−1.909	0.937	−0.226	−2.037	0.043	−3.759	−0.059
Fractional shortening	0.003	0.146	0.003	0.020	0.984	−0.285	0.291

Table 8 Linear regression for the average length of stay

Coefficients
Model	Unstandardized coefficients		Standardized coefficients	t	P-value	95% CI for B
	B	Standard error	β			Lower bound	Upper bound
Ejection fraction	0.010	0.096	0.017	0.105	0.916	−0.178	0.199
Age	0.013	0.039	0.029	0.333	0.740	−0.063	0.089
Gender	0.944	1.167	0.062	0.809	0.420	−1.359	3.248
Comorbidities	−0.947	2.847	−0.046	−0.333	0.740	−6.565	4.671
Hypertension	1.870	2.523	0.099	0.741	0.460	−3.109	6.848
Ischemic heart disease	2.706	1.610	0.140	1.680	0.095	−0.472	5.883
Diabetes mellitus	−0.697	1.429	−0.045	−0.488	0.626	−3.517	2.123
Dyslipidemia	0.562	2.458	0.017	0.229	0.819	−4.290	5.414
Body mass index	−0.054	0.083	−0.048	−0.646	0.519	−0.219	0.111
Intensive care unit	5.003	1.204	0.321	4.157	0.000	2.628	7.379
Left atrium size	0.782	0.857	0.075	0.912	0.363	−0.910	2.474
Left ventricle size	0.435	1.035	0.046	0.420	0.675	−1.608	2.478
Fractional shortening	0.169	0.159	0.177	1.066	0.288	−0.144	0.483
Number of admissions	0.021	0.082	0.019	0.257	0.798	−0.141	0.184