title: A Higher Cardiothoracic Ratio Is Associated with 2-Year Mortality after Hemodialysis Initiation.
abstract: A high cardiothoracic ratio (CTR) is indicative of a cardiac disorder. However, few reports have revealed an association between the CTR and mortality in patients starting hemodialysis (HD).
  
  
  METHODS
  Patients with HD initiation (n = 387; mean age, 66.7 ± 12.7 years) were divided into the following three groups according to their CTR at HD initiation: CTR <50%, 50% ≤ CTR < 55%, and CTR ≥55%. Kaplan-Meier analysis was performed to compare 2-year all-cause mortality among these groups. Furthermore, we investigated the factors affecting their 2-year mortality using a Cox proportional hazard regression analysis.
  
  
  RESULTS
  Sixty-five patients (17%) died within 2 years after HD initiation. Kaplan-Meier analysis showed that patients with CTR ≥55% had a higher mortality rate than those in the other groups. Cox proportional hazard regression analysis was performed using parameters with p values <0.1 among these three groups [sex, age, presence or absence of ischemic heart disease, hemoglobin levels, serum albumin levels, CTR, body mass index (BMI)] and confounding factors [presence or absence of diabetes mellitus, and estimated glomerular filtration rate (eGFR)]. Age, eGFR, BMI, and CTR ≥55% at HD initiation were identified as factors influencing 2-year mortality.
  
  
  CONCLUSIONS
  CTR >55% is one of the most important independent factors to affect 2-year all-cause mortality. Thus, confirming the cardiac condition of patients at HD initiation with a CTR >55% may improve their survival.
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Ito
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Ookawara
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Miyazawa
authors.affiliation: Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Hodaka
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Medical and Dental Hospital, Japan.
authors.forename: Sawako
authors.initials: S
authors.lastname: Goto
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Shindo
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Kitano
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Hirai
authors.affiliation: Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kaku
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Hoshino
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Aoi
authors.initials: A
authors.lastname: Nabata
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Honami
authors.initials: H
authors.lastname: Mori
authors.affiliation: Usui Hospital, Annaka, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Yoshida
authors.affiliation: Endocrinology and Metabolism, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kakei
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Morishita
authors.affiliation: Divisions of Nephrology, Saitama Medical Center, Jichi Medical University, Saitama, Japan; Minami-Uonuma City Hospital, Niigata, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tabei
keywords: Cardiothoracic ratio; Diabetes mellitus; Hemodialysis; Ischemic heart disease; Mortality