The cardiothoracic ratio and all-cause and cardiovascular disease mortality in patients undergoing maintenance hemodialysis: results of the MBD-5D study

Clin Exp Nephrol. 2017 Oct;21(5):797-806. doi: 10.1007/s10157-017-1380-2. Epub 2017 May 15.


Background: The cardiothoracic ratio (CTR) is a non-invasive left ventricular hypertrophy index. However, whether CTR associates with cardiovascular disease (CVD) and mortality in hemodialysis (HD) populations is unclear.

Methods: Using a Mineral and Bone disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D Study) subcohort, 2266 prevalent HD patients (age 62.8 years, female 38.0%, HD duration 9.4 years) with secondary hyperparathyroidism (SHPT) whose baseline CTR had been recorded were selected. We evaluated associations between CTR and all-cause death, CVD death, or composite events in HD patients.

Results: CTR was associated significantly with various background and laboratory characteristics. All-cause death, CVD-related death, and composite events increased across the CTR quartiles (Q). Adjusted hazard risk (HR) for all-cause death was 1.4 (95% confidential interval, 0.9-2.1) in Q2, 1.9 (1.3-2.9) in Q3, and 2.6 (1.7-4.0) in Q4, respectively (Q1 as a reference). The corresponding adjusted HR for CVD-related death was 1.8 (0.8-4.2), 3.1 (1.4-6.8), and 3.5 (1.6-7.9), and that for composite outcome was 1.2 (1.0-1.6), 1.7 (1.3-2.2), and 1.8 (1.5-2.3), respectively. Exploratory analysis revealed that there were relationships between CTR and age, sex, body mass index, comorbidity of CVD, dialysis duration and intact parathyroid hormone, phosphorus, hemoglobin, and usage of phosphate binder [corrected].

Conclusion: CTR correlated with all-cause death, CVD death, and composite events in HD patients with SHPT.

Keywords: CKD-MBD; Cardiothoracic ratio; Cardiovascular disease; Hemodialysis; MBD-5D study.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Cause of Death
  • Comorbidity
  • Female
  • Humans
  • Hyperparathyroidism, Secondary / mortality
  • Hypertrophy, Left Ventricular / diagnostic imaging*
  • Hypertrophy, Left Ventricular / mortality*
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prevalence
  • Prospective Studies
  • Radiography, Thoracic*
  • Renal Dialysis / adverse effects
  • Renal Dialysis / mortality*
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / mortality
  • Renal Insufficiency, Chronic / therapy*
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome