Takasuke Asakawa1, Nobuhiko Joki1, Yuri Tanaka1, Toshihide Hayashi1, Hiroki Hase1, Yasuhiro Komatsu2, Ryoichi Ando3, Masato Ikeda4, Daijo Inaguma5, Toshifumi Sakaguchi6, Toshio Shinoda7, Fumihiko Koiwa8, Shigeo Negi9, Toshihiko Yamaka10, Takashi Shigematsu9. 1. Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan. 2. Department of Nephrology, Division of Internal Medicine, St. Luke's International Hospital, Tokyo, Japan. 3. Department of Nephrology, Musashino Red Cross Hospital, Tokyo, Japan. 4. Division of Nephrology and Hypertension, The Jikei University Katsushika Medical Center, Tokyo, Japan. 5. Kidney Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan. 6. Department of Nephrology, Rinku General Hospital, Osaka, Japan. 7. Dialysis Center, Kawakita General Hospital, Tokyo, Japan. 8. Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan. 9. Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan. 10. Department of Clinical Engineering, Tokyo Yamate Medical Center, Tokyo, Japan.
Abstract
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 < 0.001). The mean CTR and the prevalence of patients with a CTR >50% obviously decreased with increasing Hb levels (both p < 0.001 for trend). Univariate logistic regression analysis revealed an approximately 20% reduction in the odds ratio for complicating CTRs >50% per 1 g/dl increase in Hb. Hb levels of <9 g/dl were significantly associated with CTRs >50%. Numerical and categorical Hb remained significantly associated with CTRs >50% after adjusting for confounding variables. CONCLUSIONS: Lower Hb levels participate in progressive CTR enlargement in patients with ESKD, and maintaining Hb levels of >9 g/dl might help prevent cardiac remodeling during the predialysis phase of CKD.
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 < 0.001). The mean CTR and the prevalence of patients with a CTR >50% obviously decreased with increasing Hb levels (both p < 0.001 for trend). Univariate logistic regression analysis revealed an approximately 20% reduction in the odds ratio for complicating CTRs >50% per 1 g/dl increase in Hb. Hb levels of <9 g/dl were significantly associated with CTRs >50%. Numerical and categorical Hb remained significantly associated with CTRs >50% after adjusting for confounding variables. CONCLUSIONS: Lower Hb levels participate in progressive CTR enlargement in patients with ESKD, and maintaining Hb levels of >9 g/dl might help prevent cardiac remodeling during the predialysis phase of CKD.
Authors: Brian D Bradbury; Rachel B Fissell; Justin M Albert; Mary S Anthony; Cathy W Critchlow; Ronald L Pisoni; Friedrich K Port; Brenda W Gillespie Journal: Clin J Am Soc Nephrol Date: 2006-11-29 Impact factor: 8.237