High Prevalence of Left Ventricular Dysfunction in End-Stage Renal Disease Patients on Maintenance Hemodialysis: A Cross-Sectional Echocardiographic Study

Abstract

Background: Cardiovascular disease is the leading cause of mortality in end-stage renal disease (ESRD) patients, with left ventricular (LV) dysfunction being a common manifestation. Limited data exist on the prevalence of cardiac dysfunction among Indian ESRD patients on maintenance hemodialysis.

Objective: To assess the prevalence of LV systolic and diastolic dysfunction in ESRD patients on maintenance hemodialysis and identify associated clinical and laboratory parameters.

Methods: This cross-sectional observational study included 79 ESRD patients aged ≥18 years on maintenance hemodialysis at a tertiary care hospital in Mangalore, India, from September 2023 to August 2025. Two-dimensional transthoracic echocardiography was performed to assess LV function. Systolic dysfunction was defined as ejection fraction <50%, and diastolic dysfunction was graded using standard criteria. Pearson correlation analysis examined associations between cardiac parameters and clinical variables.

Results: The mean age was 60.4 ± 7.3 years with equal gender distribution. LV systolic dysfunction was present in 28 patients (35.44%), including 15.19% with severe dysfunction. Diastolic dysfunction affected 36 patients (45.57%), with Grade II being most common (15.19%). Overall cardiac dysfunction prevalence was 81.01%. Significant negative correlations were observed between LV ejection fraction and age (r = -0.42, p < 0.001), ESRD duration (r = -0.38, p = 0.001), and serum phosphorus (r = -0.33, p = 0.003). E/A ratio showed strong negative correlation with age (r = -0.56, p < 0.001).

Conclusion: ESRD patients on maintenance hemodialysis demonstrate exceptionally high prevalence of LV dysfunction, emphasizing the need for systematic cardiovascular screening and early intervention in this high-risk population