Related Experiment Video
Updated: Apr 16, 2026
Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Association between the Hemoglobin Level and Cardiothoracic Ratio in Patients on Incident Dialysis
Takasuke Asakawa1, Nobuhiko Joki1, Yuri Tanaka1
1Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
Insights
Lower hemoglobin (Hb) levels are linked to cardiac enlargement in end-stage kidney disease (ESKD) patients. Maintaining Hb above 9 g/dL may prevent heart remodeling before dialysis.
Area of Science:
- Nephrology
- Cardiology
- Hematology
Background:
- Cardiac remodeling is a concern in chronic kidney disease (CKD) patients.
- End-stage kidney disease (ESKD) patients often experience cardiac enlargement.
- Understanding factors contributing to cardiac remodeling is crucial for predialysis care.
Purpose of the Study:
- To investigate the association between hemoglobin (Hb) levels and cardiac enlargement in ESKD patients.
- To identify potential interventions for preventing cardiac remodeling in predialysis CKD.
Main Methods:
- Cross-sectional study of 2,249 ESKD patients starting hemodialysis.
- Examined Hb levels before the first hemodialysis session.
- Assessed cardiothoracic ratios (CTRs) and clinical factors.
Main Results:
- A negative linear correlation (r = -0.129, p < 0.001) was found between Hb levels and CTR.
- Higher Hb levels were associated with decreased CTR and lower prevalence of CTR >50% (p < 0.001 for trend).
- Hb levels <9 g/dL were significantly associated with CTRs >50%, even after adjusting for confounders.
Conclusions:
- Lower Hb levels contribute to progressive cardiac enlargement in ESKD.
- Maintaining Hb levels >9 g/dL may help prevent cardiac remodeling in predialysis CKD patients.
Background/Aim:
The present study explores associations between hemoglobin (Hb) levels and patients with cardiac enlargement in end-stage kidney disease (ESKD) to help prevent cardiac remodeling during the predialysis phase of chronic kidney disease (CKD).
Methods:
This cross-sectional study included 2,249 patients with ESKD (age, 67 ± 13 years; male, 67%; diabetic kidney disease, 41%) who started hemodialysis (HD) between January 2006 and October 2013 at eight participating hospitals. We examined associations between Hb levels immediately before the first HD session and cardiothoracic ratios (CTRs). Clinical factors associated with the CTR were also assessed.
Results:
The mean Hb level was 8.7 ± 1.6 g/dl, and the mean and median CTRs were 55.0 and 54.7%, respectively. The correlation between the Hb level and the CTR was linear and negative (r = -0.129, p < 0.001). The mean CTR and the prevalence of patients with a CTR >50% obviously decreased with increasing Hb levels (both p < 0.001 for trend). Univariate logistic regression analysis revealed an approximately 20% reduction in the odds ratio for complicating CTRs >50% per 1 g/dl increase in Hb. Hb levels of <9 g/dl were significantly associated with CTRs >50%. Numerical and categorical Hb remained significantly associated with CTRs >50% after adjusting for confounding variables.
Conclusions:
Lower Hb levels participate in progressive CTR enlargement in patients with ESKD, and maintaining Hb levels of >9 g/dl might help prevent cardiac remodeling during the predialysis phase of CKD.
More Related Videos
Related Concept Videos
01:12Hazard Ratio
For example, in a clinical trial...
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis I: Introduction
01:25Hemodialysis III: Nursing Management
01:22Heart Failure VI: Adjunct Therapies
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration