Association between the Hemoglobin Level and Cardiothoracic Ratio in Patients on Incident Dialysis.
OBJECTIVE
The present study explores associations between hemoglobin (Hb) levels and patients with cardiac enlargement in end-stage kidney disease (ESKD) to help prevent cardiac remodeling during the predialysis phase of chronic kidney disease (CKD).


METHODS
This cross-sectional study included 2,249 patients with ESKD (age, 67 ± 13 years; male, 67%; diabetic kidney disease, 41%) who started hemodialysis (HD) between January 2006 and October 2013 at eight participating hospitals. We examined associations between Hb levels immediately before the first HD session and cardiothoracic ratios (CTRs). Clinical factors associated with the CTR were also assessed.


RESULTS
The mean Hb level was 8.7 ± 1.6 g/dl, and the mean and median CTRs were 55.0 and 54.7%, respectively. The correlation between the Hb level and the CTR was linear and negative (r = -0.129, p < 0.001). The mean CTR and the prevalence of patients with a CTR >50% obviously decreased with increasing Hb levels (both p < 0.001 for trend). Univariate logistic regression analysis revealed an approximately 20% reduction in the odds ratio for complicating CTRs >50% per 1 g/dl increase in Hb. Hb levels of <9 g/dl were significantly associated with CTRs >50%. Numerical and categorical Hb remained significantly associated with CTRs >50% after adjusting for confounding variables.


CONCLUSIONS
Lower Hb levels participate in progressive CTR enlargement in patients with ESKD, and maintaining Hb levels of >9 g/dl might help prevent cardiac remodeling during the predialysis phase of CKD.
Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
Takasuke
T
Asakawa
Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
Nobuhiko
N
Joki
Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
Yuri
Y
Tanaka
Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
Toshihide
T
Hayashi
Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
Hiroki
H
Hase
Department of Nephrology, Division of Internal Medicine, St. Luke's International Hospital, Tokyo, Japan.
Yasuhiro
Y
Komatsu
Department of Nephrology, Musashino Red Cross Hospital, Tokyo, Japan.
Ryoichi
R
Ando
Division of Nephrology and Hypertension, The Jikei University Katsushika Medical Center, Tokyo, Japan.
Masato
M
Ikeda
Kidney Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Daijo
D
Inaguma
Department of Nephrology, Rinku General Hospital, Osaka, Japan.
Toshifumi
T
Sakaguchi
Dialysis Center, Kawakita General Hospital, Tokyo, Japan.
Toshio
T
Shinoda
Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
Fumihiko
F
Koiwa
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Shigeo
S
Negi
Department of Clinical Engineering, Tokyo Yamate Medical Center, Tokyo, Japan.
Toshihiko
T
Yamaka
Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Takashi
T
Shigematsu
Anemia; Cardiothoracic ratio; Erythropoiesis-stimulating agent; Left ventricular systolic dysfunction; Volume overload