title: Sagittal abdominal diameter is an independent predictor of all-cause and cardiovascular mortality in incident peritoneal dialysis patients.
abstract: OBJECTIVE
  Visceral fat has a crucial role in the development and progression of cardiovascular disease, the major cause of death in end-stage renal disease (ESRD). Although sagittal abdominal diameter (SAD), as an index of visceral fat, significantly correlated with mortality in the general population, the impact of SAD on clinical outcomes has never been explored in ESRD patients. Therefore, we sought to elucidate the prognostic value of SAD in incident peritoneal dialysis (PD) patients.
  
  
  METHODS
  We prospectively determined SAD by lateral abdominal X-ray at PD initiation, and evaluated the association of SAD with all-cause and cardiovascular mortality in 418 incident PD patients.
  
  
  RESULTS
  The mean SAD was 24.5 ± 4.3 cm, and during a mean follow-up of 39.4 months, 97 patients (23.2%) died, and 49.4% of them died due to cardiovascular disease. SAD was a significant independent predictor of all-cause [3rd versus 1st tertile, HR (hazard ratio): 3.333, 95% CI (confidence interval): 1.514-7.388, P = 0.01; per 1 cm increase, HR: 1.071, 95% CI: 1.005-1.141, P = 0.03] and cardiovascular mortality (3rd versus 1st tertile, HR: 8.021, 95% CI: 1.994-32.273, P = 0.01; per 1 cm increase, HR: 1.106, 95% CI: 1.007-1.214, P = 0.03). Multivariate fractional polynomial analysis also showed that all-cause and cardiovascular mortality risk increased steadily with higher SAD values. In addition, SAD provided higher predictive value for all-cause (AUC: 0.691 vs. 0.547, P<0.001) and cardiovascular mortality (AUC: 0.644 vs. 0.483, P<0.001) than body mass index (BMI). Subgroup analysis revealed higher SAD (≥ 24.2 cm) was significantly associated with all-cause mortality in men, women, younger patients (<65 years), and patients with lower BMI (<22.3 kg/m(2)).
  
  
  CONCLUSIONS
  SAD determined by lateral abdominal X-ray at PD initiation was a significant independent predictor of all-cause and cardiovascular mortality in incident PD patients. Estimating visceral fat by SAD could be useful to stratify mortality risk in these patients.
authors.affiliation: Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Lee
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Shin
authors.forename: Seung Jun
authors.initials: SJ
authors.lastname: Kim
authors.forename: Dong Eun
authors.initials: DE
authors.lastname: Yoo
authors.forename: Kwang Il
authors.initials: KI
authors.lastname: Ko
authors.forename: Hyang Mo
authors.initials: HM
authors.lastname: Koo
authors.forename: Chan Ho
authors.initials: CH
authors.lastname: Kim
authors.forename: Fa Mee
authors.initials: FM
authors.lastname: Doh
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Kyu Hun
authors.initials: KH
authors.lastname: Choi
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
mesh_terms: D000005:Abdomen / Q000473:pathology*; D000328:Adult; D000368:Aged; D001837:Body Weights and Measures; D002318:Cardiovascular Diseases / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011237:Predictive Value of Tests; D011446:Prospective Studies