Modified creatinine index and risk for cardiovascular events and all-cause mortality in patients undergoing hemodialysis: The Q-Cohort study

Hokuto Arase, Shunsuke Yamada, Ryusuke Yotsueda, Masatomo Taniguchi, Hisako Yoshida, Masanori Tokumoto, Toshiaki Nakano, Kazuhiko Tsuruya, Takanari Kitazono

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and aims: The modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr levels, and Kt/V for urea, reflects skeletal muscle mass in patients on hemodialysis. Whether the modified Cr index is associated with cardiovascular events and all-cause mortality remains unknown. Methods: A total of 3027 patients registered in the Q-Cohort Study, a multicenter, prospective study of patients on hemodialysis in Japan, were analyzed. The main outcomes were cardiovascular events and all-cause mortality. Associations between sex-specific quartiles of the modified Cr index and outcomes were analyzed by the Cox proportional hazard models and the Fine–Gray proportional subdistribution hazards model. Results: The modified Cr index was correlated with known nutritional and inflammatory markers. During a 4-year follow-up, 499 patients died of any cause, 372 experienced heart disease, and 194 developed stroke. The risk for all-cause mortality was significantly higher in the lower quartiles (Q1 and Q2) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals: Q1, 2.65 [1.69–4.25], Q2, 1.92 [1.27–2.94], and Q3, 1.31 [0.87–2.02]). The risk of heart disease was significantly higher in Q1 than in Q4 (hazard ratios and 95% confidence intervals: Q1, 1.64 [1.04–2.61], Q2, 1.34 [0.91–2.00], and Q3, 1.04 [0.71–1.52]). The risk of stroke was not associated with the modified Cr index. Conclusions: A lower modified Cr index is associated with an increased risk for heart disease and all-cause mortality, but not with the risk for stroke in patients on hemodialysis.

Original languageEnglish
Pages (from-to)115-123
Number of pages9
JournalAtherosclerosis
Volume275
DOIs
Publication statusPublished - Aug 2018

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Renal Dialysis
Creatinine
Cohort Studies
Mortality
Heart Diseases
Stroke
Proportional Hazards Models
Confidence Intervals
Multicenter Studies
Urea
Dialysis
Japan
Skeletal Muscle
Prospective Studies
Serum

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Modified creatinine index and risk for cardiovascular events and all-cause mortality in patients undergoing hemodialysis : The Q-Cohort study. / Arase, Hokuto; Yamada, Shunsuke; Yotsueda, Ryusuke; Taniguchi, Masatomo; Yoshida, Hisako; Tokumoto, Masanori; Nakano, Toshiaki; Tsuruya, Kazuhiko; Kitazono, Takanari.

In: Atherosclerosis, Vol. 275, 08.2018, p. 115-123.

Research output: Contribution to journalArticle

Arase, Hokuto ; Yamada, Shunsuke ; Yotsueda, Ryusuke ; Taniguchi, Masatomo ; Yoshida, Hisako ; Tokumoto, Masanori ; Nakano, Toshiaki ; Tsuruya, Kazuhiko ; Kitazono, Takanari. / Modified creatinine index and risk for cardiovascular events and all-cause mortality in patients undergoing hemodialysis : The Q-Cohort study. In: Atherosclerosis. 2018 ; Vol. 275. pp. 115-123.
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title = "Modified creatinine index and risk for cardiovascular events and all-cause mortality in patients undergoing hemodialysis: The Q-Cohort study",
abstract = "Background and aims: The modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr levels, and Kt/V for urea, reflects skeletal muscle mass in patients on hemodialysis. Whether the modified Cr index is associated with cardiovascular events and all-cause mortality remains unknown. Methods: A total of 3027 patients registered in the Q-Cohort Study, a multicenter, prospective study of patients on hemodialysis in Japan, were analyzed. The main outcomes were cardiovascular events and all-cause mortality. Associations between sex-specific quartiles of the modified Cr index and outcomes were analyzed by the Cox proportional hazard models and the Fine–Gray proportional subdistribution hazards model. Results: The modified Cr index was correlated with known nutritional and inflammatory markers. During a 4-year follow-up, 499 patients died of any cause, 372 experienced heart disease, and 194 developed stroke. The risk for all-cause mortality was significantly higher in the lower quartiles (Q1 and Q2) than in the highest quartile (Q4) as the reference group (hazard ratios and 95{\%} confidence intervals: Q1, 2.65 [1.69–4.25], Q2, 1.92 [1.27–2.94], and Q3, 1.31 [0.87–2.02]). The risk of heart disease was significantly higher in Q1 than in Q4 (hazard ratios and 95{\%} confidence intervals: Q1, 1.64 [1.04–2.61], Q2, 1.34 [0.91–2.00], and Q3, 1.04 [0.71–1.52]). The risk of stroke was not associated with the modified Cr index. Conclusions: A lower modified Cr index is associated with an increased risk for heart disease and all-cause mortality, but not with the risk for stroke in patients on hemodialysis.",
author = "Hokuto Arase and Shunsuke Yamada and Ryusuke Yotsueda and Masatomo Taniguchi and Hisako Yoshida and Masanori Tokumoto and Toshiaki Nakano and Kazuhiko Tsuruya and Takanari Kitazono",
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T1 - Modified creatinine index and risk for cardiovascular events and all-cause mortality in patients undergoing hemodialysis

T2 - The Q-Cohort study

AU - Arase, Hokuto

AU - Yamada, Shunsuke

AU - Yotsueda, Ryusuke

AU - Taniguchi, Masatomo

AU - Yoshida, Hisako

AU - Tokumoto, Masanori

AU - Nakano, Toshiaki

AU - Tsuruya, Kazuhiko

AU - Kitazono, Takanari

PY - 2018/8

Y1 - 2018/8

N2 - Background and aims: The modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr levels, and Kt/V for urea, reflects skeletal muscle mass in patients on hemodialysis. Whether the modified Cr index is associated with cardiovascular events and all-cause mortality remains unknown. Methods: A total of 3027 patients registered in the Q-Cohort Study, a multicenter, prospective study of patients on hemodialysis in Japan, were analyzed. The main outcomes were cardiovascular events and all-cause mortality. Associations between sex-specific quartiles of the modified Cr index and outcomes were analyzed by the Cox proportional hazard models and the Fine–Gray proportional subdistribution hazards model. Results: The modified Cr index was correlated with known nutritional and inflammatory markers. During a 4-year follow-up, 499 patients died of any cause, 372 experienced heart disease, and 194 developed stroke. The risk for all-cause mortality was significantly higher in the lower quartiles (Q1 and Q2) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals: Q1, 2.65 [1.69–4.25], Q2, 1.92 [1.27–2.94], and Q3, 1.31 [0.87–2.02]). The risk of heart disease was significantly higher in Q1 than in Q4 (hazard ratios and 95% confidence intervals: Q1, 1.64 [1.04–2.61], Q2, 1.34 [0.91–2.00], and Q3, 1.04 [0.71–1.52]). The risk of stroke was not associated with the modified Cr index. Conclusions: A lower modified Cr index is associated with an increased risk for heart disease and all-cause mortality, but not with the risk for stroke in patients on hemodialysis.

AB - Background and aims: The modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr levels, and Kt/V for urea, reflects skeletal muscle mass in patients on hemodialysis. Whether the modified Cr index is associated with cardiovascular events and all-cause mortality remains unknown. Methods: A total of 3027 patients registered in the Q-Cohort Study, a multicenter, prospective study of patients on hemodialysis in Japan, were analyzed. The main outcomes were cardiovascular events and all-cause mortality. Associations between sex-specific quartiles of the modified Cr index and outcomes were analyzed by the Cox proportional hazard models and the Fine–Gray proportional subdistribution hazards model. Results: The modified Cr index was correlated with known nutritional and inflammatory markers. During a 4-year follow-up, 499 patients died of any cause, 372 experienced heart disease, and 194 developed stroke. The risk for all-cause mortality was significantly higher in the lower quartiles (Q1 and Q2) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals: Q1, 2.65 [1.69–4.25], Q2, 1.92 [1.27–2.94], and Q3, 1.31 [0.87–2.02]). The risk of heart disease was significantly higher in Q1 than in Q4 (hazard ratios and 95% confidence intervals: Q1, 1.64 [1.04–2.61], Q2, 1.34 [0.91–2.00], and Q3, 1.04 [0.71–1.52]). The risk of stroke was not associated with the modified Cr index. Conclusions: A lower modified Cr index is associated with an increased risk for heart disease and all-cause mortality, but not with the risk for stroke in patients on hemodialysis.

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