Abnormal LVEF in ESRD Patients on Hemodialysis Linked to Higher Mortality and Cardiovascular Events: Study

A new study published in the journal of BMC Nephrology showed that hemodialysis patients with end-stage renal disease (ESRD) frequently have aberrant left ventricular ejection fractions (LVEFs), which are strongly linked to a higher risk of major adverse cardiovascular events (MACEs) and all-cause mortality.

Heart failure (HF) and left ventricular (LV) systolic dysfunction are two of the main causes of the increased risk of cardiovascular morbidity and mortality that patients with end-stage renal disease confront. LV systolic dysfunction is characterized by a reduced left ventricular ejection fraction, which is strongly associated with negative consequences. Thus, this study determined the incidence of aberrant LVEF in hemodialysis-treated ESRD patients and investigated the prognostic implications of different LVEF values on cardiovascular and mortality outcomes.

Between January 1, 2020, and December 31, 2021, 1,019 ESRD patients undergoing hemodialysis at People's Hospital of Guangxi Zhuang Autonomous Region participated in a retrospective cohort study. Reduced ejection fraction (LVEF ≤40%, rEF), slightly reduced ejection fraction (LVEF 41–49%, mrEF), and normal ejection fraction (LVEF ≥50%, nEF) were the 3 categories into which patients were divided based on their baseline LVEF. To evaluate the effect of LVEF levels, clinical outcomes like MACEs and all-cause mortality were examined.

Over the course of a median follow-up of 35 months (IQR, 31–51 months), 218 patients (21.4%) encountered MACEs, and 214 patients (21.0%) died. With 7.55% of patients in the mrEF group and 5.80% in the rEF group, the prevalence of aberrant LVEF was 13.35%. When compared to patients with normal LVEF, individuals with aberrant LVEF had noticeably greater rates of MACEs and all-cause death.

All-cause mortality and MACEs had odds ratios (ORs) of 2.91 (95% CI: 1.83–4.63, P < 0.001) and 4.76 (95% CI: 2.43–9.46, P < 0.001) in the rEF group, respectively. All-cause mortality and MACEs had ORs of 1.69 (95% CI: 1.09–2.62, P = 0.019) and 2.68 (95% CI: 1.54–4.68, P < 0.001) in the mrEF group, respectively.

Overall, this study found that dialysis patients frequently experience abnormal LVEF, which is strongly linked to higher rates of MACEs and all-cause death. These results emphasize how crucial it is to identify and treat faulty LVEF as soon as possible to improve the prognoses of dialysis patients.

Source:

Li, Q., Qiu, L., Long, M., Zeng, H., Lu, Z., Liu, L., Lin, Y., Ye, K., Qin, S., Wu, Q., & Ji, Q. (2025). Prevalence and prognostic impact of abnormal left ventricular ejection fraction in Hemodialysis patients with end-stage renal disease. BMC Nephrology, 26(1), 384. https://doi.org/10.1186/s12882-025-04316-8