Abstract: Objective  To investigate clinical characteristics and prognosis of the end-stage kidney disease (ESKD) patients undergoing hemodialysis and complicated with cardiorenal anemia syndrome (CRAS).  Methods This was a retrospective cohort study. We recruited the baseline demographic and clinical data of the ESKD patients undergoing hemodialysis patients and complicated with CRAS admitted to the Hospital from August 2012 to August 2021. According to the left ventricular ejection fraction (LVEF) at baseline, they were divided into LVEF ≤40% group,  LVEF ≥41% ～≤49% group, and LVEF ≥50% group. The baseline data were compared among the three groups. They were followed up until July 31, 2022 or death. Cox regression model was used to analyze the risk factors for all-cause mortality of the patients. The relationship between LVEF and all-cause mortality risk was analyzed by generalized additive model smoothing curve fitting and multivariate Cox regression model.  Results  A total of 386 ESKD hemodialysis patients with CRAS were included in this study, with a median age of 58 (46，70) years old and 252 males (65.28%). During the follow-up interval [median 32(17，52) months], 164 patients (42.49%) died. Multivariate Cox regression showed that age (HR=1.049, 95% CI: 1.033～1.064, P＜0.001), dialysis age (HR=1.007, 95% CI: 1.002～1.011, P=0.004), cerebral infarction (HR=1.748, 95% CI:1.087～2.812, P=0.021), New York Heart Association (NYHA) heart functional grade (HR=1.455, 95% CI: 1.045～2.024, P=0.026), and LVEF (HR=0.695, 95% CI: 0.579～0.836, P=0.001) were the independent predictors for all-cause mortality in ESKD hemodialysis patients with CRAS. Generalized additive model smoothing curve fitting model showed that LVEF level was linearly correlated with the mortality risk trend of the patients (log-likelihood ratio test, P=0.043).  Conclusions  LVEF is an independent protective factor for mortality risk in ESKD hemodialysis patients with CRAS. Early diagnosis and management of lower LVEF is therefore essential to prognosis of these patients.

Key words: End-stage kidney disease, Hemodialysis, Cardiorenal anemia syndrome, Left ventricular ejection fraction