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

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

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Cardiothoracic ratio by chest radiography is commonly used to assess volume status. Little is known about the relationships between cardiothoracic ratio and the incidence of clinical outcomes in patients undergoing hemodialysis (HD). Study Design Prospective cohort study. Setting & Participants 3,436 participants in the Q-Cohort Study 18 years or older who underwent maintenance HD in Japan. Predictor Cardiothoracic ratio. Outcomes & Measurements All-cause mortality and cardiovascular disease (CVD) events. Results During a 4-year follow-up period, 564 (16.4%) patients died of any cause and 590 (17.2%) developed CVD events. From baseline cardiothoracic ratios, participants were categorized into sex-specific quartiles because cardiothoracic ratio distribution differed by sex. The 4-year event-free survival rate, in terms of all-cause mortality and CVD events, was significantly lower with higher cardiothoracic ratios. Compared to the lowest cardiothoracic ratio (quartile 1), multivariable-adjusted HRs for all-cause mortality were 0.89 (95% CI, 0.66-1.20), 1.41 (1.08-1.86), and 1.52 (1.17-2.00) in patients from quartiles 2, 3, and 4, respectively. Similarly, in comparison to quartile 1, multivariable-adjusted HRs for CVD events were 1.00 (95% CI, 0.77-1.31), 1.18 (0.92-1.53), and 1.37 (1.07-1.76) in patients from quartiles 2, 3, and 4, respectively. Furthermore, the combination of higher cardiothoracic ratio and normohypotension (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) was associated with higher risk for CVD events. Limitations Single measurement of all variables, potentially less-heterogeneous patient population, and limited ascertainment of cardiac parameters and the outcomes. Conclusions Higher cardiothoracic ratio is associated with higher risk for both all-cause mortality and CVD events in patients undergoing HD.

Original languageEnglish
Pages (from-to)84-92
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume70
Issue number1
DOIs
Publication statusPublished - Jul 2017

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Renal Dialysis
Cohort Studies
Cardiovascular Diseases
Mortality
Blood Pressure
Sex Distribution
Radiography
Disease-Free Survival
Japan
Thorax
Survival Rate
Maintenance
Prospective Studies
Incidence
Population

All Science Journal Classification (ASJC) codes

  • Nephrology

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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.

In: American Journal of Kidney Diseases, Vol. 70, No. 1, 07.2017, p. 84-92.

Research output: Contribution to journalArticle

Yotsueda, Ryusuke ; Taniguchi, Masatomo ; Tanaka, Shigeru ; Eriguchi, Masahiro ; Fujisaki, Kiichiro ; Torisu, Kumiko ; Masutani, Kosuke ; Hirakata, Hideki ; Kitazono, Takanari ; Tsuruya, Kazuhiko. / Cardiothoracic Ratio and All-Cause Mortality and Cardiovascular Disease Events in Hemodialysis Patients : The Q-Cohort Study. In: American Journal of Kidney Diseases. 2017 ; Vol. 70, No. 1. pp. 84-92.
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abstract = "Background Cardiothoracic ratio by chest radiography is commonly used to assess volume status. Little is known about the relationships between cardiothoracic ratio and the incidence of clinical outcomes in patients undergoing hemodialysis (HD). Study Design Prospective cohort study. Setting & Participants 3,436 participants in the Q-Cohort Study 18 years or older who underwent maintenance HD in Japan. Predictor Cardiothoracic ratio. Outcomes & Measurements All-cause mortality and cardiovascular disease (CVD) events. Results During a 4-year follow-up period, 564 (16.4{\%}) patients died of any cause and 590 (17.2{\%}) developed CVD events. From baseline cardiothoracic ratios, participants were categorized into sex-specific quartiles because cardiothoracic ratio distribution differed by sex. The 4-year event-free survival rate, in terms of all-cause mortality and CVD events, was significantly lower with higher cardiothoracic ratios. Compared to the lowest cardiothoracic ratio (quartile 1), multivariable-adjusted HRs for all-cause mortality were 0.89 (95{\%} CI, 0.66-1.20), 1.41 (1.08-1.86), and 1.52 (1.17-2.00) in patients from quartiles 2, 3, and 4, respectively. Similarly, in comparison to quartile 1, multivariable-adjusted HRs for CVD events were 1.00 (95{\%} CI, 0.77-1.31), 1.18 (0.92-1.53), and 1.37 (1.07-1.76) in patients from quartiles 2, 3, and 4, respectively. Furthermore, the combination of higher cardiothoracic ratio and normohypotension (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) was associated with higher risk for CVD events. Limitations Single measurement of all variables, potentially less-heterogeneous patient population, and limited ascertainment of cardiac parameters and the outcomes. Conclusions Higher cardiothoracic ratio is associated with higher risk for both all-cause mortality and CVD events in patients undergoing HD.",
author = "Ryusuke Yotsueda and Masatomo Taniguchi and Shigeru Tanaka and Masahiro Eriguchi and Kiichiro Fujisaki and Kumiko Torisu and Kosuke Masutani and Hideki Hirakata and Takanari Kitazono and Kazuhiko Tsuruya",
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AU - Yotsueda, Ryusuke

AU - Taniguchi, Masatomo

AU - Tanaka, Shigeru

AU - Eriguchi, Masahiro

AU - Fujisaki, Kiichiro

AU - Torisu, Kumiko

AU - Masutani, Kosuke

AU - Hirakata, Hideki

AU - Kitazono, Takanari

AU - Tsuruya, Kazuhiko

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N2 - Background Cardiothoracic ratio by chest radiography is commonly used to assess volume status. Little is known about the relationships between cardiothoracic ratio and the incidence of clinical outcomes in patients undergoing hemodialysis (HD). Study Design Prospective cohort study. Setting & Participants 3,436 participants in the Q-Cohort Study 18 years or older who underwent maintenance HD in Japan. Predictor Cardiothoracic ratio. Outcomes & Measurements All-cause mortality and cardiovascular disease (CVD) events. Results During a 4-year follow-up period, 564 (16.4%) patients died of any cause and 590 (17.2%) developed CVD events. From baseline cardiothoracic ratios, participants were categorized into sex-specific quartiles because cardiothoracic ratio distribution differed by sex. The 4-year event-free survival rate, in terms of all-cause mortality and CVD events, was significantly lower with higher cardiothoracic ratios. Compared to the lowest cardiothoracic ratio (quartile 1), multivariable-adjusted HRs for all-cause mortality were 0.89 (95% CI, 0.66-1.20), 1.41 (1.08-1.86), and 1.52 (1.17-2.00) in patients from quartiles 2, 3, and 4, respectively. Similarly, in comparison to quartile 1, multivariable-adjusted HRs for CVD events were 1.00 (95% CI, 0.77-1.31), 1.18 (0.92-1.53), and 1.37 (1.07-1.76) in patients from quartiles 2, 3, and 4, respectively. Furthermore, the combination of higher cardiothoracic ratio and normohypotension (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) was associated with higher risk for CVD events. Limitations Single measurement of all variables, potentially less-heterogeneous patient population, and limited ascertainment of cardiac parameters and the outcomes. Conclusions Higher cardiothoracic ratio is associated with higher risk for both all-cause mortality and CVD events in patients undergoing HD.

AB - Background Cardiothoracic ratio by chest radiography is commonly used to assess volume status. Little is known about the relationships between cardiothoracic ratio and the incidence of clinical outcomes in patients undergoing hemodialysis (HD). Study Design Prospective cohort study. Setting & Participants 3,436 participants in the Q-Cohort Study 18 years or older who underwent maintenance HD in Japan. Predictor Cardiothoracic ratio. Outcomes & Measurements All-cause mortality and cardiovascular disease (CVD) events. Results During a 4-year follow-up period, 564 (16.4%) patients died of any cause and 590 (17.2%) developed CVD events. From baseline cardiothoracic ratios, participants were categorized into sex-specific quartiles because cardiothoracic ratio distribution differed by sex. The 4-year event-free survival rate, in terms of all-cause mortality and CVD events, was significantly lower with higher cardiothoracic ratios. Compared to the lowest cardiothoracic ratio (quartile 1), multivariable-adjusted HRs for all-cause mortality were 0.89 (95% CI, 0.66-1.20), 1.41 (1.08-1.86), and 1.52 (1.17-2.00) in patients from quartiles 2, 3, and 4, respectively. Similarly, in comparison to quartile 1, multivariable-adjusted HRs for CVD events were 1.00 (95% CI, 0.77-1.31), 1.18 (0.92-1.53), and 1.37 (1.07-1.76) in patients from quartiles 2, 3, and 4, respectively. Furthermore, the combination of higher cardiothoracic ratio and normohypotension (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) was associated with higher risk for CVD events. Limitations Single measurement of all variables, potentially less-heterogeneous patient population, and limited ascertainment of cardiac parameters and the outcomes. Conclusions Higher cardiothoracic ratio is associated with higher risk for both all-cause mortality and CVD events in patients undergoing HD.

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