Determinants and prognostic importance of cardiomegaly among new ESRD patients in the United States

• Published in: Annals of epidemiology 2004-10, Vol.14 (9), p.676-685
• Main Authors: Stack, Austin G., Serna, Humberto, Ramsanahie, Anthony, Henry, Charles
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cardiomegaly; Cardiomegaly - complications; Cardiomegaly - ethnology; Cardiomegaly - mortality; Clinical Correlates; Female; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - ethnology; Kidney Failure, Chronic - mortality; Male; Middle Aged; Odds Ratio; Peritoneal Dialysis; Prevalence; Pre–End-stage Renal Disease Care; Prognosis; Risk Factors; Survival; Survival Analysis; United States - epidemiology
• ISSN: 1047-2797; 1873-2585
• DOI: 10.1016/j.annepidem.2004.01.001

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. 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. 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 BMI30.0 compared with referent [21.1–23.3 Kg/m2]) 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]). 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.