Echocardiography reveals heart abnormalities in 86% of hemodialysis patients

Nearly nine in ten patients on long-term hemodialysis show structural or functional heart abnormalities on echocardiography, according to a cross-sectional study of 100 adults treated at the Dezful Nephrology Center in southwestern Iran. The findings, published in BMC Medical Imaging, link specific cardiac phenotypes to both classic cardiovascular risk factors and dialysis-related characteristics, including low blood triglycerides, low body mass index, and the type of vascular access used for dialysis.

The research team screened 160 adults receiving chronic hemodialysis and enrolled the 100 who met predefined inclusion and exclusion criteria. Every participant underwent transthoracic echocardiography, a widely available ultrasound technique that measures chamber sizes, wall thickness, pumping function, valve performance, and filling pressures. The investigators then tested associations between imaging findings and a broad set of clinical variables: age, sex, diabetes, hypertension, body mass index, dyslipidemia, coronary and non-coronary vascular disease, dialysis access type, time on dialysis, anemia, plasma lipid concentrations, and resting heart rate.

Abnormalities were strikingly common. Eighty-six percent of the patients had at least one echocardiographic abnormality, underscoring the extent of cardiac remodeling in this population. Because end-stage kidney disease imposes volume overload, pressure stress, and metabolic strain on the heart, systematic imaging-based assessment is considered essential for cardiovascular risk stratification in dialysis units.

To identify which factors independently predicted each cardiac outcome, the researchers first performed bivariate analyses and then multivariable logistic regression, reporting adjusted odds ratios with 95 percent confidence intervals. Left ventricular systolic dysfunction, a weakening of the heart’s pumping capacity, was independently associated with hypertension (adjusted odds ratio 2.80, 95 percent CI 1.30–6.00), coronary artery disease (aOR 6.10, 95 percent CI 1.90–19.60), non-coronary vascular disease (aOR 4.20, 95 percent CI 1.30–13.60), and lower plasma triglyceride concentrations (aOR 0.99 per mg/dL, 95 percent CI 0.98–0.995).

Diabetes emerged as the dominant driver of two other phenotypes. It was associated with diastolic dysfunction, in which the heart muscle stiffens and fills inadequately (aOR 2.60, 95 percent CI 1.10–6.20), and with moderate-to-severe mitral or tricuspid regurgitation, the leakage of blood backward through the heart’s right-sided and left-sided valves (aOR 2.40, 95 percent CI 1.00–5.70). Both associations suggest that metabolic disease leaves a distinct imprint on the dialysis heart beyond the pumping failure linked to vascular disease.

The type of dialysis access also mattered. Access type and non-coronary vascular disease were linked to left ventricular hypertrophy, the thickening of the heart’s main pumping chamber that develops under chronic pressure and volume load. An arteriovenous fistula, the surgically created connection between an artery and a vein that most dialysis patients rely on, creates a persistent high-flow circuit that can add to cardiac output demands, and the study identified fistula access among the dialysis-related parameters independently tied to specific echocardiographic phenotypes.

Right ventricular abnormality followed a different pattern. Lower plasma triglycerides, a higher resting heart rate, and non-coronary vascular disease were each associated with abnormalities of the chamber that pumps blood to the lungs. Meanwhile, a higher aortic index, a measure related to the aortic root, was associated with lower body mass index and lower plasma triglycerides. The recurring signal from low triglycerides and low BMI is notable because both are sometimes interpreted as markers of poor nutritional reserve or systemic inflammation in dialysis patients, a state the authors’ data associate with adverse cardiac phenotypes rather than protection.

The authors conclude that echocardiographic abnormalities are highly prevalent in this cohort and independently associated with both traditional cardiovascular risk factors and selected dialysis-related parameters, supporting closer clinical attention to these variables when stratifying cardiac risk in hemodialysis patients. They also caution that the cross-sectional design and modest sample size mean the results represent associations rather than causal effects, and the findings come from a single center in southwestern Iran, so generalization to other dialysis populations will require further study.

Subject of Research: Echocardiographic abnormalities and their clinical and dialysis-related associations in chronic hemodialysis patients

Article Title: Evaluation of echocardiographic abnormalities and associated factors in 100 hemodialysis patients

Article References: Saadatifar, H., Marashi, K., Eslamifar, Z., Rostami, S., Kasani, A., & Khajehrezaei, S. (2026). Evaluation of echocardiographic abnormalities and associated factors in 100 hemodialysis patients. BMC Medical Imaging. https://doi.org/10.1186/s12880-026-02968-y

Image Credits: AI Generated

DOI: 10.1186/s12880-026-02968-y

Keywords: hemodialysis, echocardiography, left ventricular systolic dysfunction, diastolic dysfunction, left ventricular hypertrophy, diabetes, hypertension, triglycerides, arteriovenous fistula, cardiovascular risk stratification, cross-sectional study, kidney disease