Haemodynamically irrelevant pericardial effusion is associated with increased mortality in maintenance hemodialysis patients with end-stage renal disease

Abstract

Abstract Background Pericardial effusion (PE) is common in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis (MHD). The prognostic value of a small, haemodynamically non-compromising PE in patients with ESRD who undergo MHD, is currently lacking. Objective The purpose of this study was to determine the predictive significance of a small, haemodynamically non-compromising PE in MHD patients with ESRD. Methods and results Patients with ESRD who received regular dialysis in the Hemodialysis Center of the Fifth Affiliated Hospital of Sun Yat-sen University from January 2017 to December 2020 were retrospectively analyzed. A total of 352 patients with ESRD receiving MHD were enrolled in this study, including 82 patients with PE and 270 patients without PE. The overall median follow-up time was 2.4 years. Compared to the non-PE group, the mortality rate was higher in the PE group (31.7% vs. 18.5%; P = 0.011). PE was associated with an increased all-cause mortality. The Cox proportional hazard model showed that PE was the risk factor for all-cause death (HR: 1.964; 95%CI: 1.020–3.784; P = 0.044), as well as age (HR: 1.049; 95%CI: 1.022–1.076; P = 0.001), diabetes (HR: 2.404; 95%CI: 1.226–4.713; P = 0.011), hemoglobin (HR: 0.983; 95%CI: 0.969–0.997; P = 0.020) and ultrafiltration rate (HR: 1.082; 95%CI: 1.015–1.153; P = 0.015). Echocardiographic follow-up results showed that the mortality rate in the PE persistence group was significantly higher than that in the PE regression group (44.1% vs. 20.7%, P = 0.049). Conclusion In MHD patients with ESRD, even haemodynamically irrelevant PE is associated with an increased risk of all-cause mortality. Clinical trial number Not applicable.

Keywords

• End-stage renal disease
• Hemodialysis
• Pericardial effusion
• All-cause death
• Cardiac death