Diastolic dysfunction and the risk of end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease

Purpose: Left ventricular diastolic dysfunction (LVDD) is common in chronic kidney disease (CKD) and is suggested to be linked to worse renal prognosis. We investigated the associations between both the ratio of early mitral inflow velocity to early diastolic tissue velocity (E/e’) and LVDD grades with the risk of end-stage kidney disease (ESKD). Methods: This prospective cohort study included individuals with non-dialysis-dependent CKD from the nephrology outpatient clinics at Rigshospitalet and Herlev-Gentofte hospital, Copenhagen. All participants underwent a thorough, protocolized echocardiographic examination. The outcome was time to ESKD (defined as dialysis treatment or kidney transplantation). Results: A total of 731 participants were included. Mean age was 57 ± 13 years and 39% were female. During a median follow-up of 3.8 years (IQR: 3.3;4.5), 102 individuals reached ESKD. In multivariable Cox regression models, both increasing continuous E/e’ (HR = 1.09 [95%CI:1.03;1.15], P = 0.004, per 1 unit increase) and E/e’ > 14 (HR = 3.44 [95%CI:1.44;8.26], P = 0.005) (reference E/e’ < 8) were associated with ESKD, while E/e’ 8–14 was not. Compared with no or indeterminate LVDD, LVDD grades 2 or 3 were associated with ESKD (HR = 2.92 [95% CI:1.44;5.94], P = 0.003), while LVDD grade 1 was not. E/e’ > 14 and LVDD grade 2 or 3 demonstrated similar predictive accuracy with excellent specificity and negative predictive values, but poor positive predictive values and sensitivity. Conclusion: Prominent LVDD assessed by E/e’ and LVDD grades was independently associated with worse renal prognosis and had similar predictive accuracy in patients with non-dialysis dependent CKD.