Temporal Changes in Left Ventricular Ejection Fraction After Initiating Hemodialysis

INTRODUCTION: Longitudinal changes in left ventricular ejection fraction (LVEF) after commencing hemodialysis and their prognostic implications remain poorly characterized. METHODS: We studied 278 patients who started hemodialysis between 2010 and 2022, underwent echocardiography within 90 days, and had at least one follow-up study. LVEF trajectories were analyzed using linear mixed-effects models and locally weighted scatterplot smoothing. Mortality was assessed using baseline, 1-year landmark, and time-updated LVEF categories. RESULTS: LVEF initially improved but then declined in the 32 patients with a baseline LVEF ≤ 40%, whereas it remained stable in those with a baseline LVEF > 40%. Baseline LVEF ≤ 40% was associated with higher mortality (adjusted HR: 2.97, 95% CI: 1.38-6.37), with mortality risk increasing if LVEF remained ≤ 40% at 1 year. Time-updated LVEF ≤ 40% was independently associated with mortality (adjusted HR: 4.41, 95% CI: 2.37-8.22). CONCLUSIONS: LVEF changes dynamically after initiation of hemodialysis, and serial assessments identify patients at higher risk of mortality.