Objective To analyze the abnormal parameters of echocardiography and related risk factors in patients with maintenance hemodialysis (MHD), and to explore the correlation between abnormal parameters and patients' prognosis.

Methods Patients with MHD in Department of Nephrology, Zhongshan Hospital, Fudan University in June 2017 were prospectively enrolled and followed up to December 2021. The abnormal echocardiography parameters, prognosis and cause of death were recorded. The left ventricular mass (LVM) and left ventricular mass index (LVMI) were calculated, and the patients with left ventricular hypertrophy (LVH) or abnormal relative wall thickness (RWT) were recorded. Binary logistic regression model was used to analyze the correlation between LVH, abnormal RWT and clinical variables, laboratory indicators. Multivariate Cox regression model was used to analyze the risk factors affecting the prognosis of patients with MHD. Kaplan-Meier and log-rank test were used to analyze the effects of abnormal echocardiographic parameters on the prognosis.

Results A total of 453 patients were included in the study. The proportion of atrial structural abnormalities was higher than that of ventricular structural abnormalities (63.79% vs 48.34%), the proportion of diastolic dysfunction was higher than that of systolic dysfunction (75.72% vs 5.96%). Among the 453 patients, 269 (59.38%) patients had LVH, 207 (45.70%) patients had abnormal RWT, and 139 (30.68%) patients had both LVH and abnormal RWT. Binary logistic regression analysis showed that LVH was significantly correlated with pulmonary artery systolic pressure, serum calcium, N-terminal pro-brain natriuretic peptide (NT-proBNP), gender, and with or without aortic regurgitation (P < 0.05). Abnormal RWT was positively correlated with cardiac troponin T (cTnT, P＝0.029). During the 5-year follow-up period, 210 (46.36%) patients died, with cardiovascular events accounting for 14.76%. Multivariate Cox regression analysis showed that aortic valve calcification, reduced immunoglobulin M (IgM) and elevated cTnT were independent ralated factors for death (P < 0.05). Kaplan-Meier and log-rank tests showed that the survival time of patients without LVH (P＝0.020) and patients with normal RWT (P＝0.006) was significantly longer, and survival time of patients with aortic valve calcification (P < 0.001), mitral valve calcification (P < 0.001), moderate and severe aortic regurgitation (P＝0.023) and tricuspid regurgitation (P < 0.001) was significantly shorter.

Conclusions Abnormal echocardiographic parameters are common in patients with MHD, and the overall prognosis of patients with LVH, abnormal RWT, valvular calcification or valvular regurgitation is poorer.