Abstract: FR-PO0553
Association of Cardiothoracic Ratio with All-Cause and Cardiovascular Mortality in Patients Undergoing Peritoneal Dialysis: A Multicenter Prospective Cohort Study
Session Information
- Home Dialysis: Clinical Epidemiology
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Okamura, Kazuhiro, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Tsuneyoshi, Shoji, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Kitamura, Hiromasa, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Yamada, Shunsuke, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Tsuruya, Kazuhiko, Nara Kenritsu Ika Daigaku Igakubu Igakuka Daigakuin Igaku Kenkyuka, Kashihara, Nara Prefecture, Japan
- Ago, Tetsuro, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Nakano, Toshiaki, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
Background
Peritoneal dialysis (PD) is an established modality of kidney replacement therapy; however, patients undergoing PD are at high risk of cardiovascular disease (CVD) morbidity and mortality. While the cardiothoracic ratio (CTR), derived from chest radiographs, has been investigated as a prognostic marker in other kidney disease populations, its predictive significance in patients undergoing PD is not well established. This study aimed to clarify the association between baseline CTR and the risk of all-cause and cardiovascular mortality in patients undergoing PD.
Methods
We analyzed data from the Fukuoka Peritoneal Dialysis Registry (F-PDR), a multicenter prospective cohort study. The study included 972 patients who initiated PD between January 1, 2011, and December 31, 2020, continued PD for at least 90 days, and had baseline CTR measurements. CTR was categorized into quartiles (Q1: <45.9%; Q2: 46.0-49.6%; Q3: 49.7-53.6%; Q4: ≥53.7%) and was also analyzed as a continuous variable. The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders.
Results
Over a median follow-up of 731 days, 156 all-cause deaths (16.0%) and 54 cardiovascular deaths (5.6%) occurred. After multivariable adjustment, compared to the lowest quartile (Q1), patients in the highest quartile (Q4) had significantly increased risks of all-cause mortality (HR 2.35; 95% CI 1.39-3.96; p=0.002) and cardiovascular mortality (HR 3.59; 95% CI 1.38-9.36; p=0.011). Each one standard deviation (SD) increase in CTR was associated with a higher risk of all-cause mortality (adjusted HR 1.34; 95% CI 1.13-1.59; p<0.001) and cardiovascular mortality (adjusted HR 1.63; 95% CI 1.20-2.22; p=0.003).
Conclusion
An elevated baseline CTR is independently associated with an increased risk of both all-cause and cardiovascular mortality in patients undergoing PD. CTR may serve as an accessible clinical marker to help identify patients undergoing PD at higher risk for adverse outcomes.