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Purpose <p>Left ventricular diastolic dysfunction (LVDD) is common in chronic kidney disease (CKD) and is suggested to be linked to worse renal prognosis. We investigated the associations between both the ratio of early mitral inflow velocity to early diastolic tissue velocity (E/e’) and LVDD grades with the risk of end-stage kidney disease (ESKD).</p> Methods <p>This prospective cohort study included individuals with non-dialysis-dependent CKD from the nephrology outpatient clinics at Rigshospitalet and Herlev-Gentofte hospital, Copenhagen. All participants underwent a thorough, protocolized echocardiographic examination. The outcome was time to ESKD (defined as dialysis treatment or kidney transplantation).</p> Results <p>A total of 731 participants were included. Mean age was 57 ± 13 years and 39% were female. During a median follow-up of 3.8 years (IQR: 3.3;4.5), 102 individuals reached ESKD. In multivariable Cox regression models, both increasing continuous E/e’ (HR = 1.09 [95%CI:1.03;1.15], P = 0.004, per 1 unit increase) and E/e’ &gt; 14 (HR = 3.44 [95%CI:1.44;8.26], P = 0.005) (reference E/e’ &lt; 8) were associated with ESKD, while E/e’ 8–14 was not. Compared with no or indeterminate LVDD, LVDD grades 2 or 3 were associated with ESKD (HR = 2.92 [95% CI:1.44;5.94], P = 0.003), while LVDD grade 1 was not. E/e’ &gt; 14 and LVDD grade 2 or 3 demonstrated similar predictive accuracy with excellent specificity and negative predictive values, but poor positive predictive values and sensitivity.</p> Conclusion <p>Prominent LVDD assessed by E/e’ and LVDD grades was independently associated with worse renal prognosis and had similar predictive accuracy in patients with non-dialysis dependent CKD.</p> Graphical abstract <p>Diastolic dysfunction and the risk of ESKD among patients with non-dialysis-dependent CKD. The CPH-CKD study is a prospective cohort study of non-dialysis dependent CKD patients. All participants were systematically examined with a pre-defined protocolized echocardiography and followed for median 3.8 years- A total of 731 were included in the study sample and 102 developed ESKD. We found a significant, independent association between LVDD assessed by E/e’ and LVDD grades and worse renal prognosis in patients with non-dialysis dependent CKD. E/e’ and LVDD grading had similar predictive accuracy. Abbreviations: CKD (chronic kidney disease), ESKD (end-stage kidney disease), E/e’ (ratio of early mitral inflow velocity to early diastolic tissue velocity), LVDD (left ventricular diastolic dysfunction).</p> <p></p>

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Diastolic dysfunction and the risk of end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月9日

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  • Mathilde Zeuthen Pedersen,
  • Kristoffer Grundtvig Skaarup,
  • Nino Emanuel Landler,
  • Flemming Javier Olsen,
  • Jacob Christensen,
  • Niklas Dyrby Johansen,
  • Mats Christian Højbjerg Lassen,
  • Christina Christoffersen,
  • Ellen Linnea Freese Ballegaard,
  • Ida Maria Hjelm Sørensen,
  • Sasha Saurbrey Bjergfelt,
  • Susanne Bro,
  • Bo Feldt-Rasmussen,
  • Ditte Hansen,
  • Tor Biering-Sørensen

摘要

Purpose

Left ventricular diastolic dysfunction (LVDD) is common in chronic kidney disease (CKD) and is suggested to be linked to worse renal prognosis. We investigated the associations between both the ratio of early mitral inflow velocity to early diastolic tissue velocity (E/e’) and LVDD grades with the risk of end-stage kidney disease (ESKD).

Methods

This prospective cohort study included individuals with non-dialysis-dependent CKD from the nephrology outpatient clinics at Rigshospitalet and Herlev-Gentofte hospital, Copenhagen. All participants underwent a thorough, protocolized echocardiographic examination. The outcome was time to ESKD (defined as dialysis treatment or kidney transplantation).

Results

A total of 731 participants were included. Mean age was 57 ± 13 years and 39% were female. During a median follow-up of 3.8 years (IQR: 3.3;4.5), 102 individuals reached ESKD. In multivariable Cox regression models, both increasing continuous E/e’ (HR = 1.09 [95%CI:1.03;1.15], P = 0.004, per 1 unit increase) and E/e’ > 14 (HR = 3.44 [95%CI:1.44;8.26], P = 0.005) (reference E/e’ < 8) were associated with ESKD, while E/e’ 8–14 was not. Compared with no or indeterminate LVDD, LVDD grades 2 or 3 were associated with ESKD (HR = 2.92 [95% CI:1.44;5.94], P = 0.003), while LVDD grade 1 was not. E/e’ > 14 and LVDD grade 2 or 3 demonstrated similar predictive accuracy with excellent specificity and negative predictive values, but poor positive predictive values and sensitivity.

Conclusion

Prominent LVDD assessed by E/e’ and LVDD grades was independently associated with worse renal prognosis and had similar predictive accuracy in patients with non-dialysis dependent CKD.

Graphical abstract

Diastolic dysfunction and the risk of ESKD among patients with non-dialysis-dependent CKD. The CPH-CKD study is a prospective cohort study of non-dialysis dependent CKD patients. All participants were systematically examined with a pre-defined protocolized echocardiography and followed for median 3.8 years- A total of 731 were included in the study sample and 102 developed ESKD. We found a significant, independent association between LVDD assessed by E/e’ and LVDD grades and worse renal prognosis in patients with non-dialysis dependent CKD. E/e’ and LVDD grading had similar predictive accuracy. Abbreviations: CKD (chronic kidney disease), ESKD (end-stage kidney disease), E/e’ (ratio of early mitral inflow velocity to early diastolic tissue velocity), LVDD (left ventricular diastolic dysfunction).