Cardiothoracic ratio, inflammation, malnutrition, and mortality in diabetes patients on maintenance hemodialysis.
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.
Yen
Tzung-Hai
TH
Department of Nephrology, Chang Gung Memorial Hospital, Taipei 105, Taiwan. m19570@adm.cgmh.org.tw
Lin
Ja-Liang
JL
Lin-Tan
Dan-Tzu
DT
Hsu
Kuang-Hung
KH
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*