Cardiac Structural and Functional Alterations in End-stage Renal Disease : An Echocardiographic Study

Abstract

Background: Cardiovascular disease accounts for approximately 45% of all-cause mortality in hemodialysis patients — a risk 10 to 20 times higher than in the general population. Despite the critical role of echocardiography in characterizing this cardiac burden, systematic echocardiographic data from local dialysis centers remain scarce. Objectives: The study aims to provide a comprehensive echocardiographic characterization of end-stage of chronic kidney disease (CKD) patients on maintenance hemodialysis. We assessed left ventricular (LV) geometry, systolic function, diastolic function, and the prevalence and severity of valvular disease. Methods : Single-center cross-sectional study of 78 consecutive adults with end stage renal disease (ESRD) on maintenance hemodialysis (≥ 3 months) at the Echocardiography Department of University Hospital Mohamed VI, Marrakesh, from May 2024 to May 2025. All examinations followed the 2015 ASE/EACVI chamber quantification guidelines. Diastolic function was formally graded in 49 patients in sinus rhythm without significant mitral disease, using the 2016 ASE/EACVI four-variable algorithm. Results : Mean age 56.3 ± 12.8 years; 59.0% male. LV hypertrophy was found in 74.4%, predominantly concentric (56.4%). Only 7 patients (9.0%) had completely normal LV geometry. Reduced LV ejection fraction (EF < 50%) was present in 30.8%, with severely reduced EF (< 35%) in 12.8%. Among 49 formally evaluable patients, diastolic dysfunction was identified in 77.6%: Grade I in 32.7%, Grade II in 28.6%, Grade III in 16.3%. valvular abnormalities were found in 61.5%; moderate-to-severe aortic stenosis in 7.7%; moderate-to-severe mitral regurgitation in 15.4%; and non-rheumatic mitral stenosis in 6.4%. Elevated estimated pulmonary artery systolic pressure (> 35 mmHg) was present in 43.6%. Conclusions : End-stage CKD patients on hemodialysis carry a severe, multidimensional cardiac burden. These findings support the implementation of routine, protocol-driven echocardiographic evaluation at dialysis initiation and at regular intervals thereafter.