Abstract

Introduction
Longitudinal changes in left ventricular ejection fraction (LVEF) after commencing hemodialysis and their prognostic implications remain poorly characterized.

Methods
We studied 278 patients who started hemodialysis between 2010 and 2022, underwent echocardiography within 90 days, and had at least one follow‐up study. LVEF trajectories were analyzed using linear mixed‐effects models and locally weighted scatterplot smoothing. Mortality was assessed using baseline, 1‐year landmark, and time‐updated LVEF categories.

Results
LVEF initially improved but then declined in the 32 patients with a baseline LVEF ≤ 40%, whereas it remained stable in those with a baseline LVEF > 40%. Baseline LVEF ≤ 40% was associated with higher mortality (adjusted HR: 2.97, 95% CI: 1.38–6.37), with mortality risk increasing if LVEF remained ≤ 40% at 1 year. Time‐updated LVEF ≤ 40% was independently associated with mortality (adjusted HR: 4.41, 95% CI: 2.37–8.22).

Conclusions
LVEF changes dynamically after initiation of hemodialysis, and serial assessments identify patients at higher risk of mortality.