Cardiothoracic Ratio, Inflammation, Malnutrition, and Mortality in Diabetes Patients on Maintenance Hemodialysis

Abstract

This study investigates diabetic patients on maintenance hemodialysis (HD), and examines whether cardiothoracic ratio (CTR), malnutrition, and inflammation are closely interrelated, and whether CTR predicts short-term mortality in this population. A 2-year longitudinal study that enrolls 179 patients-73 without cardiomegaly (CTR <50%), 81 with mild cardiomegaly (CTR 50%-60%), and 25 with moderate-to-severe cardiomegaly (CTR >60%). Spearman analysis established that CTR was positively correlated with age (P < 0.001) and high sensitivity C reactive protein (HsCRP) (P < 0.05), but negatively correlated with albumin (P < 0.05) and creatinine (P < 0.001). Multivariate logistic analyses identified age (P = 0.0027), creatinine (P = 0.0484), intact-PTH (P = 0.0197) and HsCRP (P = 0.0247) were independent determinants of cardiomegaly. After 2 years, 31 of 179 (17.32%) patients died including 9 of 25 (36%) with CTR >60%, 14 of 81 (17.28%) with CTR 50%-60%, and 8 of 73 (10.96%) with CTR <50%. The primary causes of death were infection (61.29%) and cardiovascular disease (CVD) (32.26%). Cox multivariable regression analysis revealed CTR >50% was the only independent variable for the development of all-cause and infection-cause mortality in 2 years. Kaplan-Meier analysis confirmed that patients with CTR >60% suffered higher cumulative mortality than patients with CTR <50% (P = 0.0003). CTR does not only correlate with inflammation and nutritional status in diabetic patients on maintenance HD, but also predict the all-cause and infection-cause 2-year mortality.