Association between the Hemoglobin Level and Cardiothoracic Ratio in Patients on Incident Dialysis

作者：Asakawa Takasuke; Joki Nobuhiko^*; Tanaka Yuri; Hayashi Toshihide; Hase Hiroki; Komatsu Yasuhiro; Ando Ryoichi; Ikeda Masato; Inaguma Daijo; Sakaguchi Toshifumi; Shinoda Toshio; Koiwa Fumihiko; Negi Shigeo; Yamaka Toshihiko; Shigematsu Takashi

来源：CardioRenal Medicine, 2014, 4(3-4): 189-200.

DOI：10.1159/000368200

• Cardiothoracic ratio
• Volume overload
• Erythropoiesis-stimulating agent
• Anemia
• Left ventricular systolic dysfunction

Background/Aim: The present study explores associations between hemoglobin (Hb) levels and patients with cardiac enlargement in end-stage kidney disease (ESKD) to help prevent cardiac remodeling during the predialysis phase of chronic kidney disease (CKD). Methods: This cross-sectional study included 2,249 patients with ESKD (age, 67 +/- 13 years; male, 67%; diabetic kidney disease, 41%) who started hemodialysis (HD) between January 2006 and October 2013 at eight participating hospitals. We examined associations between Hb levels immediately before the first HD session and cardiothoracic ratios (CTRs). Clinical factors associated with the CTR were also assessed. Results: The mean Hb level was 8.7 +/- 1.6 g/dl, and the mean and median CTRs were 55.0 and 54.7%, respectively. The correlation between the Hb level and the CTR was linear and negative (r = -0.129, p %26lt; 0.001). The mean CTR and the prevalence of patients with a CTR %26gt;50% obviously decreased with increasing Hb levels (both p %26lt; 0.001 for trend). Univariate logistic regression analysis revealed an approximately 20% reduction in the odds ratio for complicating CTRs %26gt;50% per 1 g/dl increase in Hb. Hb levels of %26lt;9 g/dl were significantly associated with CTRs %26gt;50%. Numerical and categorical Hb remained significantly associated with CTRs %26gt;50% after adjusting for confounding variables. Conclusions: Lower Hb levels participate in progressive CTR enlargement in patients with ESKD, and maintaining Hb levels of %26gt;9 g/dl might help prevent cardiac remodeling during the predialysis phase of CKD.

• 出版日期2014