Index of Left Ventricular Diastolic Dysfunction Early After Peritoneal Dialysis Initiation May Be Associated with Patient and Technique Survival

Background: Left ventricular diastolic dysfunction (LVDD) is an early cardiac function change associated with cardiovascular complications and poor prognosis in patients with kidney disease. It has been reported that E/e', a marker of LVDD, is associated with mortality and cardiovascular events in maintenance dialysis patients. We investigated the association between E/e' assessed early after peritoneal dialysis (PD) initiation and adverse outcomes. Methods: This retrospective observational study included patients who started PD from 2009 to 2023 at our hospital. The septal and lateral E/e’ ratios obtained from transthoracic echocardiography performed within 6 months after PD initiation were used to calculate their mean value (E/e' ave). The relationship between E/e' ave and outcomes, death and PD withdrawal (transition to hemodialysis), was evaluated. Results: This study included 75 incident PD patients with a median age of 64.6 years. The median time from PD initiation to echocardiography examination was 3.3 months. When patients were divided into two groups based on the median E/e' ave of 9.4, results from Kaplan-Meier analysis showed that the higher E/e’ ave group had a significantly higher mortality and PD discontinuation rate than the lower E/e’ ave group (log rank, p < .001). Cox proportional hazards models demonstrated that E/e' ave greater than 9.4 may be an independent risk factor for death or PD discontinuation (HR [95%CI] = 2.79 [1.25–6.18]). There were significant positive correlations between E/e' ave and age, BNP, and D/P Cr (correlation coefficients are 0.31, 0.36, and 0.26, respectively), and negative correlation between E/e’ ave and serum creatinine (correlation coefficients was -0.36). The value of E/e’ ave was significantly higher in the patient group with diabetes and left ventricular hypertrophy than that without them. Conclusion: Higher E/e' ratio early after PD initiation might be associated with death and PD withdrawal, possibly suggesting an association between impaired LVDD and poor outcome.