Ogata Hiroaki, Kumasawa Junji, Fukuma Shingo, Mizobuchi Masahide, Kinugasa Eriko, Fukagawa Masafumi, Fukuhara Shunichi, Akizawa Tadao
Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigsaki-chuo 35-1, Tsuzuki, Yokohama, Kanagawa, 224-8503, Japan.
Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Clin Exp Nephrol. 2017 Oct;21(5):797-806. doi: 10.1007/s10157-017-1380-2. Epub 2017 May 15.
The cardiothoracic ratio (CTR) is a non-invasive left ventricular hypertrophy index. However, whether CTR associates with cardiovascular disease (CVD) and mortality in hemodialysis (HD) populations is unclear.
Using a Mineral and Bone disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D Study) subcohort, 2266 prevalent HD patients (age 62.8 years, female 38.0%, HD duration 9.4 years) with secondary hyperparathyroidism (SHPT) whose baseline CTR had been recorded were selected. We evaluated associations between CTR and all-cause death, CVD death, or composite events in HD patients.
CTR was associated significantly with various background and laboratory characteristics. All-cause death, CVD-related death, and composite events increased across the CTR quartiles (Q). Adjusted hazard risk (HR) for all-cause death was 1.4 (95% confidential interval, 0.9-2.1) in Q2, 1.9 (1.3-2.9) in Q3, and 2.6 (1.7-4.0) in Q4, respectively (Q1 as a reference). The corresponding adjusted HR for CVD-related death was 1.8 (0.8-4.2), 3.1 (1.4-6.8), and 3.5 (1.6-7.9), and that for composite outcome was 1.2 (1.0-1.6), 1.7 (1.3-2.2), and 1.8 (1.5-2.3), respectively. Exploratory analysis revealed that there were relationships between CTR and age, sex, body mass index, comorbidity of CVD, dialysis duration and intact parathyroid hormone, phosphorus, hemoglobin, and usage of phosphate binder [corrected].
CTR correlated with all-cause death, CVD death, and composite events in HD patients with SHPT.
心胸比率（CTR）是一种无创的左心室肥厚指标。然而，在血液透析（HD）人群中，CTR是否与心血管疾病（CVD）及死亡率相关尚不清楚。
采用日本慢性肾脏病5D期患者矿物质和骨代谢紊乱结局研究（MBD - 5D研究）的亚队列，选取2266例患有继发性甲状旁腺功能亢进（SHPT）且已记录基线CTR的HD患者（年龄62.8岁，女性占38.0%，HD病程9.4年）。我们评估了HD患者中CTR与全因死亡、CVD死亡或复合事件之间的关联。
CTR与各种背景和实验室特征显著相关。全因死亡、CVD相关死亡和复合事件在CTR四分位数（Q）间均有所增加。全因死亡的校正风险比（HR）在Q2为1.4（95%置信区间，0.9 - 2.1），Q3为1.9（1.3 - 2.9），Q4为2.6（1.7 - 4.0），以Q1作为参照。CVD相关死亡的相应校正HR分别为1.8（0.8 - 4.2）、3.1（1.4 - 6.8）和3.5（1.6 - 7.9），复合结局的校正HR分别为1.2（1.0 - 1.6）、1.7（1.3 - 2.2）和1.8（1.5 - 2.3）。探索性分析显示，CTR与年龄、性别、体重指数、CVD合并症、透析时长以及全段甲状旁腺激素、磷、血红蛋白和磷结合剂使用情况[校正后]之间存在关联。
在患有SHPT的HD患者中，CTR与全因死亡、CVD死亡和复合事件相关。
