Cardiothoracic Ratio and All-Cause Mortality and Cardiovascular Disease Events in Hemodialysis Patients: The Q-Cohort Study

Yotsueda, Ryusuke; Taniguchi, Masatomo; Tanaka, Shigeru; Eriguchi, Masahiro; Fujisaki, Kiichiro; Torisu, Kumiko; Masutani, Kosuke; Hirakata, Hideki; Kitazono, Takanari; Tsuruya, Kazuhiko

doi:10.1053/j.ajkd.2016.11.026

Cited by 56 publications

(51 citation statements)

References 29 publications

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“…In fact, CEs have been reported concurrently as the largest single cause of mortality in dialysis patients. [16][17][18] The finding that ASA > 3 is independently associated with CEs is expected since other reports confirm a significant association between comorbidity and adverse postoperative outcomes. [19][20][21][22][23] Findings of our study suggest that perioperative blood transfusions independently increase rates of post-TEVAR CEs; however, this association should be interpreted cautiously.…”

Section: Discussionmentioning

confidence: 78%

Predictors and Outcomes of Cardiac Events following Thoracic Endovascular Aortic Repair in Descending Thoracic Aortic Aneurysm and Dissection

et al. 2020

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Background Cardiac events following thoracic endovascular aortic repair (TEVAR) have been associated with significant morbidity and mortality. However, predictors of post-TEVAR cardiac events in descending thoracic aortic aneurysm or dissection are poorly understood. Methods A retrospective analysis of completed TEVAR procedures performed from 2010 to 2016 was conducted using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) participant user file database. Adult patients (≥18 years) who underwent TEVAR for descending thoracic aortic aneurysm or dissection were identified and 30-day outcomes were examined. An initial univariate analysis was performed to determine associations between all patient variables and cardiac events, defined as myocardial infarction or cardiac arrest that occurred ≤30 days of surgery. Multivariate logistic regression was subsequently performed to identify independent risk factors for cardiac events following TEVAR. Results The study identified 150 out of 2,905 (5.2%) patients who underwent TEVAR for descending thoracic aortic aneurysm or dissection who developed cardiac events. No significant difference in incidence of cardiac events was noted among patients presenting with aortic aneurysm or dissection (p = 0.339). The overall 30-day mortality rate for all patients was 9.1%. Independent preoperative predictors of post-TEVAR cardiac events included emergency procedure (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.9–4.1, p < 0.01); American Society of Anesthesiologists score >3 (OR 1.71, 95% CI 1.1–2.6, p = 0.01), ventilator dependence (OR 2.33, 95% CI 1.3–4.2, p < 0.01), renal failure (OR 2.53, 95% CI 1.50–4.3, p < 0.01), blood transfusion (OR 1.84, 95% CI 1.1–3.2, p = 0.03), and preoperative leukocytosis (OR 2.45, 1.6–3.8, p < 0.01). After TEVAR, unplanned reintubation (OR 5.52, 95% CI 3.5–8.8, p < 0.01), prolonged mechanical ventilation (OR 1.94, 95% CI 1.2–3.2, p = 0.011), and postoperative blood transfusion (OR 4.02, 95% CI 2.70–6.0, p < 0.01) were independent predictors of cardiac events. Cardiac events greatly increased mortality (60.7 vs. 5.5%), total length of hospital stay (13.2 ± 14.7 days vs. 8.3 ± 9.3 days), and readmission rates (19.3 vs. 8.2%, p < 0.01). Conclusions Cardiac events following TEVAR are associated with significant mortality. Patients with these risk factors should be appropriately monitored to improve outcomes.

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Section: Discussionmentioning

confidence: 78%

Predictors and Outcomes of Cardiac Events following Thoracic Endovascular Aortic Repair in Descending Thoracic Aortic Aneurysm and Dissection

et al. 2020

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“…However, an autopsy study has reported a satisfactory association between CTR and heart size [ 29 ]. Moreover, some studies have disclosed that CTR had significant association with CV mortality [ 9 , 12 , 14 ] or CV events [ 11 , 13 ] in patients on CHD. Thereafter, an elevated CTR may indicate heart problem in certain extent and then it allows us to use CTR as the surrogate of ventricular remodeling in patients on CHD because CTR is a simple and inexpensive method.…”

Section: Discussionmentioning

confidence: 99%

Association between serum aluminum levels and cardiothoracic ratio in patients on chronic hemodialysis

Wang¹,

Fang

Leu

et al. 2017

PLoS ONE

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The cardiothoracic ratio (CTR) and serum aluminum levels are both associated with mortality in hemodialysis patients. However, limited data regarding the association between serum aluminum levels and the CTR have been published to date. Therefore, we aimed to elucidate this association in patients on chronic hemodialysis (CHD). We investigated the association between the serum aluminum level and the CTR in CHD in a retrospective cross-sectional study of 547 Taiwanese patients on CHD. The mean age of patients was 62.5±13.2 years, with a mean hemodialysis time of 7.1±5.2 years. Among the patients, 36.9% were diabetic and 47.9% were male. After natural logarithmic transformation (ln(aluminum)), the serum aluminum level exhibited an independent and linear relationship with the CTR (β: 1.40, 95% confidence interval (CI), 0.6–2.2). A high serum aluminum level (≥6 ng/dL) was significantly associated with a CTR >0.5 in the crude analysis (odds ratio (OR): 2.15, 95% CI, 1.52–3.04) and remained significant after multivariable adjustment (OR: 2.45, 95% CI, 1.63–3.67). Moreover, the ln(aluminum) value was significantly associated with a CTR >0.5 (OR: 1.71, 95%CI, 1.28–2.29) in multivariable analysis, indicating a dose effect of aluminum on cardiomegaly. In conclusion, the serum aluminum level was independently associated with cardiac remodeling (elevated CTR) in patients on CHD.

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“…18 years old undergoing HD in 39 dialysis facilities in Saga and Fukuoka Prefectures, Kyushu, Japan. The details of this study have been described previously (14)(15)(16). Patients were enrolled from December 2006 to December 2007.…”

Section: Design Of the Q-cohort Study And Study Populationmentioning

confidence: 99%

The Association between Dialysis Dose and Risk of Cancer Death in Patients Undergoing Hemodialysis: The Q-Cohort Study

et al. 2020

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Objective Uremic toxins are known risk factors for cancer in patients undergoing hemodialysis (HD). Although adequate removal of uremic toxins might reduce the cancer risk by improving subclinical uremia, the relationship between the dialysis dose and risk of cancer death in patients undergoing HD remains unclear. Methods In this prospective observational study, 3,450 patients undergoing HD were followed up for 4 years. The primary outcome was cancer death. Patients were divided into quartiles according to their baseline Kt/V levels. The association between the Kt/V levels and risk of cancer death was estimated using the Kaplan-Meier method and Cox proportional-hazards model. Results A total of 111 patients (3.2%) died from cancer during the 4-year observational period. The 4-year survival rate decreased linearly with decreasing Kt/V. The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer death were 2.23 (95% CI, 1.13-4.56), 1.77 (0.88-3.63), and 1.89 (1.04-3.56) in quartile (Q)1, Q2, and Q3, respectively, compared with patients in the highest Kt/V category (Q4) (P for trend = 0.06). Every 0.1 increase in Kt/V was associated with a reduction of 8% in cancer death (HR 0.92, 95% CI 0.85-0.99). Conclusion A lower dialysis dose might be associated with a higher risk of cancer death in patients undergoing HD. Kt/V is a simple indicator of dialysis dose used in clinical practice and might be a useful modifiable factor for predicting the risk of cancer death. Further basic and interventional studies are needed to confirm the apparent reduction in cancer death associated with increasing the dialysis dose.

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Cardiothoracic Ratio and All-Cause Mortality and Cardiovascular Disease Events in Hemodialysis Patients: The Q-Cohort Study

Abstract: Higher cardiothoracic ratio is associated with higher risk for both all-cause mortality and CVD events in patients undergoing HD.

Cited by 56 publications

References 29 publications

Predictors and Outcomes of Cardiac Events following Thoracic Endovascular Aortic Repair in Descending Thoracic Aortic Aneurysm and Dissection

Predictors and Outcomes of Cardiac Events following Thoracic Endovascular Aortic Repair in Descending Thoracic Aortic Aneurysm and Dissection

Association between serum aluminum levels and cardiothoracic ratio in patients on chronic hemodialysis

The Association between Dialysis Dose and Risk of Cancer Death in Patients Undergoing Hemodialysis: The Q-Cohort Study

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