Clinical impact of cardiac ejection fraction and atrial fibrillation on elderly hemodialysis patients

作者：Kim DW, Hong YA, Shin SJ, Kwon SH, Chung S, Hyun YY, Yu BC, Yang JW, Hwang WM, Cho JH, Yoo KD, Sun IO, Ko GJ, Kim H, Park WY, Bae E, Song SH · 发表于：Archives of gerontology and geriatrics · 年份：2026 · DOI：10.1016/j.archger.2026.106140 · 研究领域：Atrial Fibrillation、Renal Dialysis、Stroke Volume、Kidney Failure, Chronic、Humans、Female、Retrospective Studies、Male、Aged、Republic of Korea、Aged, 80 and over、Proportional Hazards Models

BACKGROUND: This study aimed to investigate all-cause mortality in elderly patients starting hemodialysis (HD) according to left ventricular ejection fraction [LVEF] and atrial fibrillation (AF). METHODS: We analyzed 1,137 incident HD patients aged ≥70 years from a retrospective multicenter cohort of the Korean Society of Geriatric Nephrology. All-cause mortality was evaluated within the first 6 months and beyond 6 months using a landmark analysis (median follow-up, 3.7 years) according to LVEF and AF status. Sequential Cox proportional hazards models were applied, adjusted for demographic and clinical factors. RESULTS: Patients were classified into four groups according to LVEF (≥50% vs. <50%) and AF status. After full adjustment, neither reduced LVEF nor AF was independently associated with 6-month mortality. Early mortality was mainly associated with older age, lower serum albumin, and impaired mobility. In the 6-month landmark analysis, compared with patients with preserved LVEF and no AF, those with reduced LVEF without AF (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.01-1.65), preserved LVEF with AF (HR 1.35, 95% CI 1.02-1.80), and reduced LVEF with AF (HR 1.69, 95% CI 1.03-2.79) had progressively higher long-term mortality risks. CONCLUSIONS: In elderly patients initiating HD, reduced LVEF and AF were independently associated with higher long-term mortality, whereas short-term mortality was predominantly driven by frailty and nutritional status rather than...