Abstract
Purpose Cardiomegaly is a radiographic abnormality of major prognostic importance in the general population. We explored the clinical correlations and mortality impact of cardiomegaly in new end-stage renal disease (ESRD) patients from the Dialysis Morbidity and Mortality Study Wave 2. Methods Radiographic data denoting the presence or absence of cardiomegaly were available for 97% (n=3908) of the entire cohort. Multivariate logistic regression explored relationships between potential uremic factors and known traditional cardiovascular disease (CVD) factors with cardiomegaly and Cox regression estimated the mortality risk associations over 2 years. Results The prevalence of cardiomegaly was 26%. Multivariate analysis identified: age (adjusted odds ratio [OR]=1.30 per 10 years older), black race (OR=1.33) diabetes (OR=1.26), hypertension (OR=1.28), tobacco use (OR=1.17), serum albumin (OR=1.36 per 1 g/dL lower), and extremes of body mass index (BMI) (OR=1.24 for BMI<21.1 and OR=1.10 for BMI>30.0 compared with referent [21.1-23.3 Kg/m 2]) as significant correlates. The impact of cardiomegaly on mortality was greatest in the first 12 months (RR=1.56; CI, 1.33-1.83) and persisted for up to 2 years (RR=1.44; CI, 1.27-1.62). Interestingly, the likelihood of cardiomegaly was significantly lower for patients who received regular care during the pre-ESRD period (erythropoietin use [OR=0.79] and nephrology visits [OR=0.80 for ≥2 vs. less]). Conclusions Traditional CVD risk factors were the predominant correlates of cardiomegaly in new ESRD patients. Vigorous CVD risk factor reduction strategies and frequent specialist care during the pre-ESRD period may be beneficial in reducing the prevalence of cardiomegaly and attenuating its impact on survival.
Original language | English |
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Pages (from-to) | 676-685 |
Number of pages | 10 |
Journal | Annals of Epidemiology |
Volume | 14 |
Issue number | 9 |
DOIs | |
Publication status | Published - Oct 2004 |
Externally published | Yes |
Keywords
- adjusted odds ratio
- Cardiomegaly
- cardiovascular
- CHF
- Clinical Correlates
- congestive heart failure
- CVD
- DMMS
- end-stage renal disease
- ESRD
- left ventricular hypertrophy
- LVH
- OR
- Pre-End-stage Renal Disease Care
- Survival