Combination of Left Ventricular Ejection Fraction and End-Diastolic Diameter and Outcomes in Patients on Peritoneal Dialysis: A Multicenter Retrospective Study

Background: End-stage renal disease (ESRD) is often complicated by left ventricular dysfunction, which is associated with a poor prognosis. This study aims to investigate the association between baseline left ventricular ejection fraction (LVEF) plus left ventricular end-diastolic diameter (LVEDD) with outcomes in peritoneal dialysis (PD) patients. Methods: In this multicenter retrospective study, 1511 incident Chinese patients on PD between January 1, 2005 and December 31, 2021 were enrolled. Restricted cubic splines (RCS) were used to explore the non-linear associations between LVEF+LVEDD and the risk of mortality. Parametric models for interval-censored survival-time data (stintreg) were used to examine the association between LVEF+LVEDD quartiles and the outcomes. Results: During 6451.11 person-years of follow-up [median 4.81 (IQR 3.61-6.81) years], 247 (17.8%) patients died, including 88 cardiovascular deaths. RCS showed a U-shaped association between LVEF+LVEDD and the risks of all-cause and CV mortality. According to the quartiles, the optimal range of LVEF+LVEDD associated with the lowest risk of all-cause and CV mortality was 103 to 107, which was set as the reference range. Both higher (≥115) and lower (<103) levels of LVEF+LVEDD were associated with increased risks of all-cause mortality (hazard ratio [HR] 2.20, 95% confidence interval [CI] 1.58-3.07; HR 1.68, 95% CI 1.19-2.36) and cardiovascular mortality (HR 2.51, 95% CI 1.33-4.75; HR 1.86, 95% CI 0.96-3.61). Conclusion: Low and high levels of baseline LVEF+LVEDD were associated with increased risks of all-cause and cardiovascular mortality in PD patients.