Predictive Value of Fatigue, Diastolic Dysfunction, and Right Ventricular Function for Mortality in Hemodialysis Patients with Preserved Ejection Fraction: A 4-Year Prospective Follow- Up Study

Background Chronic kidney disease (CKD) is a significant global cause of mortality, particularly due to cardiovascular complications. In patients with end-stage kidney disease (ESKD), fatigue is a highly prevalent symptom that has been linked to diastolic and right ventricular (RV) dysfunction. While left ventricular assessment is routine, the prognostic significance of RV function, specifically in patients with preserved left ventricular ejection fraction (LVEF), remains insufficiently explored. This study aims to investigate the impact of fatigue, diastolic dysfunction, and RV function on the survival of hemodialysis (HD) patients with preserved LVEF. Methods In this prospective cohort study, 94 HD patients with preserved LVEF were followed for 48 months. Baseline assessments included fatigue severity measured by the Visual Analog Scale for Fatigue (VAS-F) and echocardiographic parameters, including the E/e' ratio for diastolic function and Tricuspid Annular Plane Systolic Excursion (TAPSE) for RV function. Predictors of mortality were identified using univariate and multivariate Cox proportional hazards regression models. Results During the 4-year follow-up, all-cause mortality occurred in 41 patients (43.6%). Non-survivors had significantly higher E/e' ratios (p = 0.017) and lower TAPSE values (p = 0.003) compared to survivors. While VAS-F scores were higher in the mortality group, the difference was not statistically significant (p = 0.138). In the multivariate Cox regression model, TAPSE was identified as the only independent predictor of mortality (Hazard Ratio [HR]: 0.87; 95% Confidence Interval [CI]: 0.78–0.97; p = 0.012), with each 1 mm decrease in TAPSE increasing the risk of death by 13%. LVEF, E/e' ratio, and VAS-F score were not independent predictors in the multivariate analysis. Conclusion In HD patients with preserved LVEF, right ventricular function ‘as measured by TAPSE’ is a more powerful independent predictor of mortality than diastolic dysfunction or clinical fatigue severity. Routine monitoring of TAPSE may be critical for identifying high-risk patients and improving cardiovascular risk assessment in this population.