title: Cardiothoracic ratio, inflammation, malnutrition, and mortality in diabetes patients on maintenance hemodialysis.
abstract: BACKGROUND
  This study investigates diabetic patients on maintenance hemodialysis (HD), and examines whether cardiothoracic ratio (CTR), malnutrition, and inflammation are closely interrelated, and whether CTR predicts short-term mortality in this population.
  
  
  METHODS
  A 2-year longitudinal study that enrolls 179 patients-73 without cardiomegaly (CTR <50%), 81 with mild cardiomegaly (CTR 50%-60%), and 25 with moderate-to-severe cardiomegaly (CTR >60%).
  
  
  RESULTS
  Spearman analysis established that CTR was positively correlated with age (P < 0.001) and high sensitivity C reactive protein (HsCRP) (P < 0.05), but negatively correlated with albumin (P < 0.05) and creatinine (P < 0.001). Multivariate logistic analyses identified age (P = 0.0027), creatinine (P = 0.0484), intact-PTH (P = 0.0197) and HsCRP (P = 0.0247) were independent determinants of cardiomegaly. After 2 years, 31 of 179 (17.32%) patients died including 9 of 25 (36%) with CTR >60%, 14 of 81 (17.28%) with CTR 50%-60%, and 8 of 73 (10.96%) with CTR <50%. The primary causes of death were infection (61.29%) and cardiovascular disease (CVD) (32.26%). Cox multivariable regression analysis revealed CTR >50% was the only independent variable for the development of all-cause and infection-cause mortality in 2 years. Kaplan-Meier analysis confirmed that patients with CTR >60% suffered higher cumulative mortality than patients with CTR <50% (P = 0.0003).
  
  
  CONCLUSIONS
  CTR does not only correlate with inflammation and nutritional status in diabetic patients on maintenance HD, but also predict the all-cause and infection-cause 2-year mortality.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Taipei 105, Taiwan. m19570@adm.cgmh.org.tw
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.forename: Kuang-Hung
authors.initials: KH
authors.lastname: Hsu
mesh_terms: D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D016019:Survival Analysis; D013909:Thorax / Q000503:physiopathology*