Hospitalization rate and outcomes in patients with left ventricular dysfunction receiving hemodialysis

International Journal of General Medicine Dovepress open access to scientific and medical research O r igi n a l R e s e a r c h International Journal of General Medicine downloaded from https://www.dovepress.com/ by 24.85.16.150 on 02-Jul-2020 For personal use only. Open Access Full Text Article Hospitalization rate and outcomes in patients with left ventricular dysfunction receiving hemodialysis This article was published in the following Dove Press journal: International Journal of General Medicine Marwan A Albeshri 1 Mohammed S Alsallum 1 Sulafa Sindi 1 Mohammed Kadi 1 Abdullah Albishri 2 Hanadi Alhozali 3 Kamal Alghalayini 3 1 College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2 College of Medicine, King Abdulaziz University-Rabigh Branch, Rabigh, Saudi Arabia; 3Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia Introduction: Left ventricular dysfunction (LVD) is characterized as left ventricular ejection fraction (EF) below half of the systolic capacity of the left ventricle. Patients on hemodialysis have higher risk of developing LVD than the general population. Our aim was to assess hospitalization rate and outcomes in hemodialysis patients with LVD. Patients and methods: All patients ≥18 years old, who started hemodialysis therapy at King Abdulaziz University Hospital between January 2011 and December 2011, were identified using medical records of hemodialysis unit. Patients were then divided into three groups, according to their EF results prior to the initiation of hemodialysis, as patients with EF <40%, EF between 40% and 49%, and EF ≥50%. Patients were then followed for 5 years by reviewing their hospital records to assess their outcomes, hospital admissions, and length of hospital stay. Results: Analysis included 333 patients. Patients with EF <40% were 40, 36 patients with EF 40%–49%, and 257 patients had an EF >50%. Patients with EF <50% were significantly older than patients with EF >50% (P=0.002). Diabetes mellitus and hypertension were more prevalent in patients with EF <40% and EF 40%–49% when compared with patients with EF >50% (P<0.001, P=0.002). The average length of stay between the three groups was significantly different (P=0.007). Intensive care unit admissions were significantly different when comparing the three groups (P=0.013) and was found to be an independent risk factor for mortality in our patients. Half of the patients with EF <40% and 44% of patients with EF of 40%–49% died compared with only 27% of patients with EF >50% (P=0.002). However, Kaplan–Meier analysis showed no significant difference in the survival time among the three groups (P=0.845). Conclusion: Mortality and morbidity increased in patients with LVD on hemodialysis compared with patients with normal EF. Keywords: LVD, hemodialysis, mortality, hospitalization Introduction Correspondence: Marwan A Albeshri College of Medicine, King Abdulaziz University, North Abdullah Al Sulaiman Road, Jeddah 21589, Saudi Arabia Tel +966 58 290 3138 Email 463 submit your manuscript | www.dovepress.com International Journal of General Medicine 2018:11 463–472 Dovepress © 2018 Albeshri et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/IJGM.S179206 Powered by TCPDF (www.tcpdf.org) Left ventricular dysfunction (LVD) is characterized as a left ventricular ejection fraction (EF) below one-half of the systolic capacity of the left ventricle. Patients on hemodialysis have 10–30 times the risk of LVD than that of the general population.1–3 Recent literature has shown a correlation between cardiovascular disease (CVD) and chronic kidney disease (CKD), and how often they coexist.2 In patients with CKD, 74% have left ventricular hypertrophy at the beginning of dialysis, and it is considered to be the most common cardiac finding in those patients.4 Previous studies have shown that CVD contributes to most of the morbidity and mortality in patients receiving hemodialysis. Patients with CVD receiving hemodialy- Dovepress International Journal of General Medicine downloaded from https://www.dovepress.com/ by 24.85.16.150 on 02-Jul-2020 For personal use only. Albeshri et al sis have up to 20 times higher mortality risk than the rest of the population.5–8 In patients with CKD, the morbidity and mortality of CVD are abnormally high in all stages of CKD, with a predominance of 80%.6,9 Patients with LVD are more prone to comorbidities, such as high blood pressure, diabetes mellitus (DM), anemia, and a low body mass index.1–3 In dialysis patients, there are multiple risk factors that lead to CVD and contribute to the prognosis. Some of these risk factors include advanced age, systemic hypertension (HTN), DM, proteinuria, obesity, cigarette smoking, and the risk factors associated with renal impairment. DM and cigarette smoking have worsening effects on dialysis patients, with DM being shown to decrease the survival rate and increase the hospitalization rate among those patients.1–3,6,9 When comparing heart failure (HF) and low EF (<40%) patients, those who were on dialysis were less likely to receive guideline-directed therapy when compared with those with no renal impairment.10 In LVD patients receiving hemodialysis, it is important to determine the impact of these risk factors on the prognosis, clinical outcome, survival rate, and prevalence of morbidity and mortality associated with this disease. Future guidelines and protocols dealing with this group of patients must be designed to improve the outcome and survival among those patients. For this research, our aim was to assess the clinical characteristics, comorbidities, hospitalization rate, and outcomes among hemodialysis patients with LVD compared with normal EF patients in the King Abdulaziz University Hospital (KAUH) Hemodialysis Unit in Jeddah, Saudi Arabia. Patients and methods Study design and participants We conducted this hospital-based retrospective cohort study at the Department of Medicine in the KAUH Hemodialysis Unit between November 2016 and September 2017 using the electronic-based patient records. All patients ≥18 years old, who started hemodialysis therapy at KAUH between January 2011 and December 2011, were identified using the hospital information system and medical records of the hemodialysis unit. The patients were then divided into three groups accordi (...truncated)