Association between serum aluminum levels and cardiothoracic ratio in patients on chronic hemodialysis.

Tzu-Lin Wang,Jyh-Gang Leu,Yu-Wei Fang,Ming-Hsien Tsai,Ming-Hsien Tsai,Yoshihiro Fukumoto

doi:10.1371/journal.pone.0190008

Tzu-Lin Wang, Jyh-Gang Leu + Show 4 more

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https://doi.org/10.1371/journal.pone.0190008

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Journal: PloS one	Publication Date: Dec 20, 2017
Citations: 4	License type: CC BY 4.0

Affiliation: Fu Jen Catholic University, National Taiwan University

Abstract

The cardiothoracic ratio (CTR) and serum aluminum levels are both associated with mortality in hemodialysis patients. However, limited data regarding the association between serum aluminum levels and the CTR have been published to date. Therefore, we aimed to elucidate this association in patients on chronic hemodialysis (CHD). We investigated the association between the serum aluminum level and the CTR in CHD in a retrospective cross-sectional study of 547 Taiwanese patients on CHD. The mean age of patients was 62.5±13.2 years, with a mean hemodialysis time of 7.1±5.2 years. Among the patients, 36.9% were diabetic and 47.9% were male. After natural logarithmic transformation (ln(aluminum)), the serum aluminum level exhibited an independent and linear relationship with the CTR (β: 1.40, 95% confidence interval (CI), 0.6–2.2). A high serum aluminum level (≥6 ng/dL) was significantly associated with a CTR >0.5 in the crude analysis (odds ratio (OR): 2.15, 95% CI, 1.52–3.04) and remained significant after multivariable adjustment (OR: 2.45, 95% CI, 1.63–3.67). Moreover, the ln(aluminum) value was significantly associated with a CTR >0.5 (OR: 1.71, 95%CI, 1.28–2.29) in multivariable analysis, indicating a dose effect of aluminum on cardiomegaly. In conclusion, the serum aluminum level was independently associated with cardiac remodeling (elevated CTR) in patients on CHD.

Highlights

The cardiothoracic ratio (CTR) is estimated by measuring the proportion of the heart size to the thoracic diameter on chest radiographs and it has been shown weakly and negatively associated with cardiac systolic dysfunction [1, 2]
The CTR distribution was stratified based on a serum aluminum level of 6 ng/mL, and the group with an aluminum level !6 ng/mL had a greater mean CTR (Fig 3)
We investigated the association between the bivariate aluminum level and a CTR >0.5 in analyses stratified by covariates including a history of diabetes mellitus (DM), previous cardiovascular disease (CVD), hemoglobin, age, and gender

Summary

Introduction

The cardiothoracic ratio (CTR) is estimated by measuring the proportion of the heart size to the thoracic diameter on chest radiographs and it has been shown weakly and negatively associated with cardiac systolic dysfunction [1, 2]. CTR could be representative of the ventricular remodeling status and is a simple method to assess the heart conditions of patients on chronic dialysis. An elevated aluminum level contributes to the development of dialysis dementia, adynamic bone disease, and anemia in patients on chronic hemodialysis (CHD) [16,17,18]. Overt aluminum toxicity is uncommon in patients on CHD [19, 20] because the aluminum in the water used for dialysis is removed by reverse osmosis and deionization. Some studies have reported that elevated serum aluminum levels are associated with mortality in patients on CHD [23, 24]. Aluminum might have a damaging effect on cardiac remodeling, as evidenced by studies showing a significant association between heart damage and aluminum levels [25, 26]

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