Factors influencing mortality in prevalent hemodialysis patients with different types of heart failure – single-center experience

Abstract

Introduction/Objective This retrospective longitudinal study aimed to analyze survival factors in prevalent hemodialysis (HD) patients with different heart failure (HF) phenotypes.

Methods Over 36 months, 96 patients were monitored, with 51 deaths recorded. Patients were categorized into HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and non-HF (no HF) groups. Demographic, clinical, and laboratory parameters were analyzed to identify survival predictors within each subgroup.

Results Survival curves did not differ among HF subgroups, and mortality was as follows: 42.9% for HFrEF, 52.4% for HFpEF, and 60.6% for no-HF patients. The main causes of death were COVID-19 infection (70%), followed by de novo cardiovascular diseases (myocardial infarction and cerebrovascular insult) (25%). Some demographic (age, male sex, HD vintage) and laboratory differences (anemia, lipids) between the surviving and deceased subgroups of patients have been found. Multivariate analysis identified distinct survival predictors: in HFrEF: pulse rate and interventricular septum thickness; in HFpEF: primary renal disease, cardiac history, and diuretic use; in no-HF: BMI, serum sodium, and HDL/LDL ratios.

Conclusion Our results led us to suspect that COVID-19 infection might have masked the expected impact of HF phenotype on patients’ survival. Obtained findings contribute to the evolving understanding of HF in prevalent HD patients in the pandemic era. As HF, dialysis, and COVID-19 intertwine, further investigation is crucial to navigate this intricate finding and optimize patient care.

Keywords: heart failure; hemodialysis; mortality; risk factors