Background: 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.
Methods: 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%).
Results: 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).
Conclusions: 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.