Spectrum of Echocardiography Findings in Patients with End-Stage Renal Disease

Abstract

Background: Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD) undergoing hemodialysis, yet the spectrum of echocardiographic abnormalities remains underexplored in South Asian populations. Echocardiography provides critical insights into structural and functional cardiac alterations, which can inform risk stratification and management strategies in this high-risk group. Objective: To determine the frequency and distribution of echocardiographic abnormalities among patients with ESRD receiving maintenance hemodialysis. Methods: A cross-sectional study was conducted at the Department of Nephrology, Khyber Teaching Hospital, Peshawar, from January to May 2025. A total of 196 adult patients with ESRD on hemodialysis for more than three months were enrolled consecutively. Transthoracic echocardiography was performed using standardized protocols to evaluate systolic function, chamber size, valvular competence, diastolic function, pericardial effusion, and pulmonary hypertension. Statistical analyses were performed using SPSS version 25, with significance set at p≤0.05. Results: Severe left ventricular dysfunction was present in 41.8% of patients, moderate dysfunction in 27.6%, and mild dysfunction in 10.7%. Left ventricular hypertrophy was identified in 15.8%, and chamber dilatation in 50.5%. Diastolic dysfunction ≥ grade 2 was observed in 21.4%. Moderate-to-severe mitral and tricuspid regurgitation were found in 23.9% and 21.9% of patients, respectively, while pulmonary hypertension was present in 21.9%. Patients with ESRD >2 years had significantly lower mean ejection fraction (37.8% vs. 40.2%, p=0.013) and higher prevalence of severe LV dysfunction (56.7% vs. 34.1%, p=0.005). Conclusion: ESRD patients on maintenance hemodialysis exhibit a high burden of cardiac abnormalities, particularly LV dysfunction and valvular regurgitation, with severity increasing over disease duration. Routine echocardiographic monitoring may enable early detection and targeted interventions to reduce cardiovascular complications.