Xiaoran Feng1, Yueqiang Wen2, Fen Fen Peng3, Niansong Wang4, Xiaojiang Zhan5, Xianfeng Wu6. 1. Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China. 2. Department of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. 3. Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, China. 4. Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, No.600, Yi Shan Road, Shanghai, China. 5. Department of Nephrology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Donghu District, Nanchang City, 330006, Jiangxi province, China. zhanxiaogang87@163.com. 6. Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, No.600, Yi Shan Road, Shanghai, China. xianfengwu2@163.com.
Abstract
BACKGROUND: Elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is an independent risk factor for cardiovascular disease (CVD) among the general population. However, an association between AST/ALT ratio and CVD mortality in patients on peritoneal dialysis (PD) has received little attention. METHODS: A total of 2224 incident PD patients from multi-centers were enrolled from November 1, 2005, to June 30, 2017, in this retrospective cohort study. The primary endpoint was CVD mortality. Eligible patients were divided into high and normal groups according to the AST/ALT ratio cut-off for CVD mortality with the receiver operating characteristic (ROC) curve. The associations between the AST/ALT ratio and CVD mortality were evaluated by the Cox regression model. RESULTS: Of eligible 1579 patients with a mean age of 49.3 ± 14.6 years, 55.4% of patients were male, 18.1% of patients had diabetes, and 64.2% of patients had hypertension. The prevalence of a high AST/ALT ratio was 76.6% in the cohort population. During a follow-up period with 4659.6 patient-years, 316 patients died, of which 193 (61.1%) deaths were caused by CVD episodes. The incidence of CVD mortality in the high group was significantly higher than that in the normal group (13.1% versus 9.2%, P = 0.024). Cumulative CVD mortality rates were significantly different between the two groups by Kaplan-Meier analysis [hazards ratio (HR) = 1.50, 95% confidence index (CI) 1.09-2.07, P = 0.014]. After adjusting for confounding factors, a higher AST/ALT ratio was independently associated with an increased risk of CVD mortality compared with their counterparts (HR = 1.43, 95%CI 1.08-2.41, P = 0.002). CONCLUSIONS: PD patients with high baseline AST/ALT ratio levels may be at a significant risk of CVD mortality.
BACKGROUND: Elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is an independent risk factor for cardiovascular disease (CVD) among the general population. However, an association between AST/ALT ratio and CVDmortality in patients on peritoneal dialysis (PD) has received little attention. METHODS: A total of 2224 incident PDpatients from multi-centers were enrolled from November 1, 2005, to June 30, 2017, in this retrospective cohort study. The primary endpoint was CVDmortality. Eligible patients were divided into high and normal groups according to the AST/ALT ratio cut-off for CVDmortality with the receiver operating characteristic (ROC) curve. The associations between the AST/ALT ratio and CVDmortality were evaluated by the Cox regression model. RESULTS: Of eligible 1579 patients with a mean age of 49.3 ± 14.6 years, 55.4% of patients were male, 18.1% of patients had diabetes, and 64.2% of patients had hypertension. The prevalence of a high AST/ALT ratio was 76.6% in the cohort population. During a follow-up period with 4659.6 patient-years, 316 patientsdied, of which 193 (61.1%) deaths were caused by CVD episodes. The incidence of CVDmortality in the high group was significantly higher than that in the normal group (13.1% versus 9.2%, P = 0.024). Cumulative CVDmortality rates were significantly different between the two groups by Kaplan-Meier analysis [hazards ratio (HR) = 1.50, 95% confidence index (CI) 1.09-2.07, P = 0.014]. After adjusting for confounding factors, a higher AST/ALT ratio was independently associated with an increased risk of CVDmortality compared with their counterparts (HR = 1.43, 95%CI 1.08-2.41, P = 0.002). CONCLUSIONS:PDpatients with high baseline AST/ALT ratio levels may be at a significant risk of CVDmortality.