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. 2020 May 5;10(1):7533.
doi: 10.1038/s41598-020-64359-9.

Vitamin D deficiency, cardiothoracic ratio, and long-term mortality in hemodialysis patients

Heng-Jung Hsu  1   2   3   4 , I-Wen Wu  1   2   4 , Kuang-Hung Hsu  5   6   7   8 , Chiao-Yin Sun  1   2   4 , Chun-Yu Chen  1   2 , Chin-Chan Lee  9   10   11
Affiliations

Vitamin D deficiency, cardiothoracic ratio, and long-term mortality in hemodialysis patients

Heng-Jung Hsu et al. Sci Rep. .

Abstract

Hemodialysis patients are a special group of patients with higher mortality rates. Hemodialysis patients with vitamin D deficiency {plasma levels of 25-hydroxyvitamin D [25(OH)D] below 20 ng/mL} are associated with even higher mortality rates. The prognostic importance of vitamin D deficiency in hemodialysis patients with different cardiothoracic ratios (CTRs) is still unclear. This prospective study was performed in a single hemodialysis center, and 186 patients were included. This study analyzed the prognostic importance of vitamin D deficiency in hemodialysis patients with different CTRs. Vitamin D deficiency patients had a significantly higher prevalence of stroke and diabetic mellitus than those without vitamin D deficiency. In addition, the CTR was higher in patients with vitamin D deficiency than in those without vitamin D deficiency. After multivariate logistic regression, we found that CTR was the solitary factor that was independently significantly associated with vitamin D deficiency [odds ratio: 1.07, 95% confidence internal (CI): 1.01-1.13, p = 0.02]. Additionally, vitamin D deficiency was associated with all-cause mortality in patients with higher CTR after adjustment in hierarchical regression models. In conclusion, we reported that vitamin D deficiency was independently significantly associated with a higher CTR. We additionally revealed that vitamin D deficiency was an independent predicator for all-cause mortality in higher CTR hemodialysis patients.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The distribution of the cardiothoracic ratio in our study patients with chronic kidney disease on hemodialysis.
Figure 2
Figure 2
The distribution of serum 25 (OH) D levels among our study patients with chronic kidney disease on hemodialysis.
Figure 3
Figure 3
The correlation between serum 25 (OH) D levels and cardiothoracic ratio in our study patients with chronic kidney disease on hemodialysis.
Figure 4
Figure 4
Five-year all-cause mortality-free Kaplan-Meier survival curves of chronic kidney disease patients on hemodialysis with 25(OH) D deficiency and normal 25 (OH) D levels (log-rank χ2: 3.65, p = 0.06).
Figure 5
Figure 5
Five-year all-cause mortality-free Kaplan-Meier survival curves in hemodialysis patients with a high cardiac thoracic ratio (CTR) (CTR over 50%) between patients with 25(OH) D deficiency and normal 25 (OH) D levels (log-rank χ2: 5.07, p = 0.02).
Figure 6
Figure 6
Five-year all-cause mortality-free Kaplan-Meier survival curves in hemodialysis patients with a low cardiac thoracic ratio (CTR) (CTR less than 50%) between individuals with 25(OH) D deficiency and normal 25 (OH) D levels (log-rank χ2: 0.03, p = 0.87).
Figure 7
Figure 7
Five-year all-cause mortality-free Cox regression survival curves in hemodialysis patients with a high cardiac thoracic ratio (CTR) (CTR over 50%) between patients with 25(OH) D deficiency and normal 25 (OH) D levels (p = 0.04).
Figure 8
Figure 8
Examples of normal cardiothoracic ratio (CTR) (CTR less than 50%) and abnormal CTR (CTR over 50%) chest X-ray images. (In case 1, the CTR is a/b = 46%; in case 2, the CTR is c/d = 58%).
See this image and copyright information in PMC

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