Abstract
Backgrounds and AimsVisceral fat has a crucial role in the development and progression of cardiovascular disease, the major cause of death in end-stage renal disease (ESRD). Although sagittal abdominal diameter (SAD), as an index of visceral fat, significantly correlated with mortality in the general population, the impact of SAD on clinical outcomes has never been explored in ESRD patients. Therefore, we sought to elucidate the prognostic value of SAD in incident peritoneal dialysis (PD) patients.MethodsWe prospectively determined SAD by lateral abdominal X-ray at PD initiation, and evaluated the association of SAD with all-cause and cardiovascular mortality in 418 incident PD patients.ResultsThe mean SAD was 24.5±4.3 cm, and during a mean follow-up of 39.4 months, 97 patients (23.2%) died, and 49.4% of them died due to cardiovascular disease. SAD was a significant independent predictor of all-cause [3rd versus 1st tertile, HR (hazard ratio): 3.333, 95% CI (confidence interval): 1.514–7.388, P = 0.01; per 1 cm increase, HR: 1.071, 95% CI: 1.005–1.141, P = 0.03] and cardiovascular mortality (3rd versus 1st tertile, HR: 8.021, 95% CI: 1.994–32.273, P = 0.01; per 1 cm increase, HR: 1.106, 95% CI: 1.007–1.214, P = 0.03). Multivariate fractional polynomial analysis also showed that all-cause and cardiovascular mortality risk increased steadily with higher SAD values. In addition, SAD provided higher predictive value for all-cause (AUC: 0.691 vs. 0.547, P<0.001) and cardiovascular mortality (AUC: 0.644 vs. 0.483, P<0.001) than body mass index (BMI). Subgroup analysis revealed higher SAD (≥24.2 cm) was significantly associated with all-cause mortality in men, women, younger patients (<65 years), and patients with lower BMI (<22.3 kg/m2).ConclusionsSAD determined by lateral abdominal X-ray at PD initiation was a significant independent predictor of all-cause and cardiovascular mortality in incident PD patients. Estimating visceral fat by SAD could be useful to stratify mortality risk in these patients.
Highlights
Cardiovascular disease is the most common cause of death in end-stage renal disease (ESRD) patients [1]
body mass index (BMI) and high-sensitivity C-reactive protein (hs-CRP) levels were significantly higher, while albumin concentrations were significantly lower in the highest sagittal abdominal diameter (SAD) tertile group
There were no significant differences in smoking status, peritoneal dialysis (PD) modality, weekly Kt/ V urea, residual renal function, systolic blood pressure, hemoglobin, serum glucose, creatinine, the ratio of total cholesterol to highdensity lipoprotein cholesterol, Ca6P products, the use of antihypertensive drugs and phosphate binders, and Left ventricular (LV) ejection fraction among the three groups
Summary
Cardiovascular disease is the most common cause of death in end-stage renal disease (ESRD) patients [1]. In addition to advanced age, hypertension, diabetes, smoking, and dyslipidemia, obesity has been established as a risk factor for cardiovascular morbidity and mortality in the general population [2,3,4,5]. Contrary to the general population, some previous epidemiologic studies have shown that high body mass index (BMI) is associated with improved outcome in ESRD patients on hemodialysis (HD), which is referred to as ‘‘reverse epidemiology’’ [6,7]. Demonstrated a significant survival advantage in PD patients with high BMI, while a cohort study by McDonald et al [8] revealed that obesity at PD initiation was an independent risk factor for death and technique failure. The United States Renal Data System Dialysis Morbidity and Mortality Wave II Study failed to find any survival advantage associated with high BMI in PD patients [10]
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