Abstract
BACKGROUND: Patients with end-stage renal disease (ESRD) face a significantly elevated risk of cardiovascular morbidity and mortality, with left ventricular (LV) systolic dysfunction and heart failure (HF) being major contributors. Reduced left ventricular ejection fraction (LVEF) defines LV systolic dysfunction and is closely linked to adverse outcomes. This study aimed to assess the prevalence of abnormal LVEF in ESRD patients receiving hemodialysis and to examine the prognostic significance of varying LVEF levels on mortality and cardiovascular outcomes. METHODS AND RESULTS: A retrospective cohort study was conducted on 1,019 ESRD patients receiving hemodialysis at People's Hospital of Guangxi Zhuang Autonomous Region between January 1, 2020, and December 31, 2021. Based on baseline LVEF, patients were classified into three groups: reduced ejection fraction (LVEF ≤ 40%, rEF), mildly reduced ejection fraction (LVEF 41-49%, mrEF), and normal ejection fraction (LVEF ≥ 50%, nEF). Clinical outcomes, including all-cause mortality and major adverse cardiovascular events (MACEs), were analyzed to assess the impact of LVEF levels. During a median follow-up of 35 months (IQR, 31-51 months), 214 patients (21.0%) died, and 218 (21.4%) experienced MACEs. The prevalence of abnormal LVEF was 13.35%, with 7.55% of patients in the mrEF group and 5.80% in the rEF group. Patients with abnormal LVEF showed significantly higher rates of all-cause mortality and MACEs than those with normal LVEF. In the rEF group, the odds ratios (ORs) for all-cause mortality and MACEs were 2.91 (95% CI: 1.83-4.63, P < 0.001) and 4.76 (95% CI: 2.43-9.46, P < 0.001), respectively. In the mrEF group, ORs for all-cause mortality and MACEs were 1.69 (95% CI: 1.09-2.62, P = 0.019) and 2.68 (95% CI: 1.54-4.68, P < 0.001), respectively. CONCLUSION: Abnormal LVEF is prevalent in ESRD patients on hemodialysis and is strongly associated with increased risks of all-cause mortality and MACEs. Lower LVEF levels correlate with poorer outcomes, underscoring the importance of early detection and targeted management strategies to improve prognosis in this high-risk population.