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Published on: October 2, 2020
A Higher Cardiothoracic Ratio Is Associated with 2-Year Mortality after Hemodialysis Initiation
Kiyonori Ito1, Susumu Ookawara1, Yuichiro Ueda1
1Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Insights
A high cardiothoracic ratio (CTR) over 55% is a significant predictor of 2-year mortality in patients starting hemodialysis (HD). Early cardiac assessment for these patients may improve survival rates.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- A high cardiothoracic ratio (CTR) often indicates cardiac disorders.
- Limited research exists on the association between CTR and mortality in patients initiating hemodialysis (HD).
Purpose of the Study:
- To investigate the relationship between cardiothoracic ratio (CTR) at hemodialysis initiation and 2-year all-cause mortality.
- To identify factors influencing mortality in patients starting hemodialysis.
Main Methods:
- 387 patients undergoing HD initiation were categorized by CTR (<50%, 50%–55%, ≥55%).
- Kaplan-Meier analysis and Cox proportional hazard regression were used to assess 2-year all-cause mortality and influencing factors.
Main Results:
- 17% of patients died within 2 years of HD initiation.
- Patients with CTR ≥55% exhibited a higher mortality rate.
- Age, estimated glomerular filtration rate (eGFR), body mass index (BMI), and CTR ≥55% were significant predictors of 2-year mortality.
Conclusions:
- A CTR >55% is a critical independent factor for 2-year all-cause mortality in HD patients.
- Assessing cardiac status in patients with CTR >55% at HD initiation could enhance survival.
Unlabelled:
A high cardiothoracic ratio (CTR) is indicative of a cardiac disorder. However, few reports have revealed an association between the CTR and mortality in patients starting hemodialysis (HD).
Methods:
Patients with HD initiation (n = 387; mean age, 66.7 ± 12.7 years) were divided into the following three groups according to their CTR at HD initiation: CTR <50%, 50% ≤ CTR < 55%, and CTR ≥55%. Kaplan-Meier analysis was performed to compare 2-year all-cause mortality among these groups. Furthermore, we investigated the factors affecting their 2-year mortality using a Cox proportional hazard regression analysis.
Results:
Sixty-five patients (17%) died within 2 years after HD initiation. Kaplan-Meier analysis showed that patients with CTR ≥55% had a higher mortality rate than those in the other groups. Cox proportional hazard regression analysis was performed using parameters with p values <0.1 among these three groups [sex, age, presence or absence of ischemic heart disease, hemoglobin levels, serum albumin levels, CTR, body mass index (BMI)] and confounding factors [presence or absence of diabetes mellitus, and estimated glomerular filtration rate (eGFR)]. Age, eGFR, BMI, and CTR ≥55% at HD initiation were identified as factors influencing 2-year mortality.
Conclusion:
CTR >55% is one of the most important independent factors to affect 2-year all-cause mortality. Thus, confirming the cardiac condition of patients at HD initiation with a CTR >55% may improve their survival.
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