Longitudinal changes of cardiothoracic ratio and vascular pedicle width as predictors of volume status during one year in Chinese peritoneal dialysis patients.
BACKGROUND
Volume overload is an important contributing factor of cardiovascular disease (CVD) in peritoneal dialysis (PD) patients. Vascular pedicle width (VPW) and cardiothoracic ratio (CTR) in routine chest radiograph are indicators of intravascular volume. Longitudinal changes of VPW and CTR may be important prognostic factors of PD patients.


METHODS
We studied 212 PD patients. Longitudinal changes in VPW (DeltaVPW) and CTR (DeltaCTR) were calculated. The relationship between radiologic measurements and clinical outcome was analyzed.


RESULTS
During the 12 months prior to enrollment, VPW rose from 53.35 +/- 5.66 to 55.40 +/- 6.30 mm (p < 0.001) and CTR rose from 53.3 +/- 7.1 to 56.0 +/- 7.8% (p < 0.001). After adjusting for confounding variables by Cox regression model, DeltaCTR is an independent predictor of hospitalization-free survival; 1% increase in CTR confers 2.9% higher risk of hospitalization (95% confidence interval 0.2-5.7%, p = 0.034). None of the radiologic measurements correlated with actuarial patient survival.


CONCLUSIONS
In chronic PD patients, DeltaCTR is an independent predictor of hospitalization-free survival. This simple radiological parameter may serve as an important parameter for the risk stratification of PD patients.
Gao
Ni
N
Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
Kwan
Bonnie Ching-Ha
BC
Chow
Kai-Ming
KM
Chung
Kwok-Yi
KY
Leung
Chi-Bon
CB
Li
Philip Kam-Tao
PK
Szeto
Cheuk-Chun
CC
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D002681:China; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D018570:Risk Assessment; D016019:Survival Analysis; D035423:Thoracic Cavity