Increased indexed proximal aortic diameter is a predictor of poor prognosis in maintenance hemodialysis patients

Figures & data

Figure 1. Flow chart of patient selection.

Table 1. Clinical features in end-stage renal disease patients grouped by ARD/BSA tertiles.

Variables	ARD/BSA tertiles (cm/m^2)
	<1.94 (n = 130)	1.94-2.15 (n = 131)	>2.15 (n = 130)	P	P-trend
Age, years	53.5 ± 13.6	56.0 ± 14.8	58.1 ± 15.2	0.038	0.011
Male, n (%)	93 (71.5)	84 (64.1)	69 (53.1)	0.008	0.003
Dialysis duration, months	19.0 (9.0, 60.0)	24.0 (10.0, 60.0)	15.0 (6.0, 43.5)	0.064	0.611
Diabetes, n (%)	56 (43.1)	37 (28.2)	30 (23.1)	0.002	0.001
Hypertension, n (%)	117 (90.0)	118 (90.1)	119 (91.5)	0.929	0.752
COPD, n (%)	5 (3.8)	6 (4.6)	7 (5.4)	0.795	0.560
Systolic WAB, mmHg	146.8 ± 15.7	142.2 ± 14.9	143.6 ± 18.0	0.203	0.199
Diastolic WAB, mmHg	84.1 ± 10.6	84.2 ± 11.2	85.0 ± 11.5	0.858	0.620
pWAB, mmHg	62.7 ± 12.6	58.1 ± 10.3	58.6 ± 13.1	0.035	0.031
Laboratory parameters
Hb, g/L	118.0 (98.8, 128.3)	114.0 (99.0, 127.0)	107.0 (94.0, 120.5)	0.025	0.024
NLR	4.0 (3.0, 6.0)	4.2 (2.7, 6.5)	4.2 (2.7, 6.4)	0.996	0.513
TCHO, mmol/L	3.6 (3.0, 4.6)	3.6 (3.0, 4.3)	3.9 (3.2, 4.7)	0.185	0.601
LDL-C, mmol/L	1.9 (1.3, 2.5)	1.7 (1.4, 2.4)	1.9 (1.4, 2.5)	0.425	0.990
HDL-C, mmol/L	0.9 (0.8, 1.2)	1.0 (0.9, 1.3)	1.2 (0.9, 1.5)	<0.001	<0.001
Albumin, g/L	39.6 (36.3, 43.0)	39.3 (36.4, 42.2)	38.9 (35.6, 41.9)	0.488	0.200
Ferritin, ng/mL	226.9 (96.8, 380.9)	249.0 (90.3, 553.6)	251.4 (91.9, 487.7)	0.662	0.087
Calcium, mmol/L	2.2 (2.1, 2.4)	2.2 (2.1, 2.4)	2.2 (2.1, 2.4)	0.707	0.714
Phosphorus, mmol/L	1.6 (1.3, 2.0)	1.6 (1.3, 2.0)	1.6 (1.3, 1.9)	0.848	0.178
Echocardiographic parameters
LVDdi, cm/m^2	2.9 (2.7, 3.2)	3.1 (2.8, 3.4)	3.3 (3.1, 3.6)	<0.001	<0.001
LVMi, g/m^2	129.2 (102.5, 160.4)	128.6 (103.0, 165.0)	139.0 (107.4, 174.0)	0.097	0.017
LVEF, %	66.0 (58.8, 71.0)	66.0 (60.0, 71.0)	66.0 (59.0, 71.0)	0.909	0.823

ARD/BSA: aortic root diameter indexed to body surface area; COPD: chronic obstructive pulmonary disease; WAB: weekly average blood pressure; pWAB: pulse weekly average blood pressure; Hb: hemoglobin; NLR: neutrophil to lymphocyte ratio; TCHO: total cholesterol; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; LVDdi: left ventricular end-diastolic diameter index; LVMi: left ventricular mass index; LVEF: left ventricular ejection fraction.

Table 2. Multiple linear regression analysis for variables correlated to ­aortic root diameter (ARD)/body surface area (BSA).

Variables	Standardized regression coefficient (β)	p-value
Age, years	0.311	<0.001
Diabetes mellitus	−0.225	<0.001
pWAB, mmHg	−0.259	<0.001
LVDdi, cm/m^2	0.372	<0.001
Hb, g/L	−0.167	0.007
HDL-C, mmol/L	0.162	0.011

pWAB: pulse weekly average blood pressure; LVDdi: left ventricular end-diastolic diameter index; Hb: hemoglobin; HDL-C, high-density lipoprotein cholesterol.

Figure 2. Kaplan-Meier analyses of clinical outcomes categorized by ARD/BSA. (A), All-cause mortality. (B), Major adverse cardiovascular events (MACE).

Table 3. Univariate and multivariate cox regression analysis for all-cause mortality.

Variables	Univariate analysis		Multivariate analysis
	HR (95% CI)	p-value	HR (95% CI)	p-value
Age, years	1.063 (1.047–1.080)	<0.001	1.050 (1.031–1.070)	<0.001
Female	1.239 (0.823–1.865)	0.304	0.974 (0.589–1.612)	0.919
BMI, kg/m²	0.967 (0.910–1.027)	0.273
Dialysis duration, months	0.997 (0.992–1.002)	0.283	1.002 (0.995–1.008)	0.615
Kt/V	1.087 (0.574–2.060)	0.797	1.224 (0.582–2.572)	0.594
Hypertension	1.238 (0.600–2.556)	0.563
AF	1.115 (0.871–1.427)	0.388
CCI, point	1.292 (1.170–1.425)	<0.001	1.155 (1.022–1.306)	0.021
LVDD, mm	1.007 (0.979–1.037)	0.619
LAD, mm	1.039 (1.008–1.072)	0.014	1.020 (0.981–1.061)	0.322
IVST, mm	0.974 (0.880–1.079)	0.619
LVEF <50%	1.641 (0.971–2.774)	0.064	1.615 (0.894–2.918)	0.112
LVH	1.513 (0.915–2.502)	0.106
NLR	1.005 (0.986–1.025)	0.602
Hb, g/L	0.985 (0.976–0.993)	0.001	0.985 (0.975–0.996)	0.005
TCHO, mmol/L	0.992 (0.898–1.096)	0.873
LDL-C, mmol/L	1.097 (0.857–1.403)	0.463
HDL-C, mmol/L	1.172 (0.683–2.013)	0.564
Albumin, g/L	0.934 (0.902–0.968)	<0.001	1.004 (0.956–1.054)	0.876
Ferritin, ng/mL	1.000 (1.000–1.001)	0.259
ARD/BSA (per 1 SD)	1.553 (1.262–1.912)	<0.001	1.403 (1.118–1.761)	0.003

BMI: body mass index; AF: atrial fibrillation; CCI: Charlson comorbidity index; LVDD: left ventricular end-diastolic diameter; LAD: left atrial diameter; IVST: interventricular septal thickness; LVEF: left ventricular ejection fraction; LVH: left ventricular hypertrophy; NLR: neutrophil to lymphocyte ratio; Hb: hemoglobin; TCHO: total cholesterol; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; ARD/BSA: aortic root diameter indexed to body surface area.

Table 4. Univariate and multivariate cox regression analysis for MACE.

Variables	Univariate analysis		Multivariate analysis
	HR (95% CI)	p-value	HR (95% CI)	p-value
Age, years	1.075 (1.055–1.095)	<0.001	1.061 (1.038–1.085)	<0.001
Female	1.429 (0.894–2.285)	0.136	0.946 (0.517–1.731)	0.857
BMI, kg/m²	1.014 (0.953–1.078)	0.668
Dialysis duration, months	0.994 (0.987–1.001)	0.082	0.995 (0.986–1.004)	0.264
Kt/V	1.150 (0.560–2.364)	0.703
Hypertension	1.482 (0.597–3.681)	0.396
AF	1.134 (0.866–1.485)	0.360
CCI, point	1.338 (1.199–1.493)	<0.001	1.259 (1.101–1.438)	0.001
LVDD, mm	0.984 (0.950–1.020)	0.384
LAD, mm	1.027 (0.990–1.065)	0.158
IVST, mm	0.945 (0.837–1.066)	0.355
LVEF < 50%	1.672 (0.916–3.052)	0.094	1.679 (0.746–3.779)	0.210
LVH	1.295 (0.742–2.259)	0.363	1.337 (0.650–2.748)	0.430
NLR	1.001 (0.974–1.028)	0.956
Hb, g/L	0.996 (0.986–1.007)	0.471
TCHO, mmol/L	1.026 (0.958–1.098)	0.471
LDL-C, mmol/L	1.291 (1.000–1.666)	0.050	1.384 (1.023–1.873)	0.035
HDL-C, mmol/L	1.385 (0.772–2.486)	0.275
Albumin, g/L	0.940 (0.901–0.980)	0.004	0.961 (0.910–1.015)	0.158
Ferritin, ng/mL	1.001 (1.000–1.001)	0.057	1.000 (1.000–1.001)	0.382
ARD/BSA (per 1 SD)	1.626 (1.281–2.064)	<0.001	1.356 (1.037–1.772)	0.026

MACE: major adverse cardiovascular events; BMI: body mass index; AF: atrial fibrillation; CCI: Charlson comorbidity index; LVDD: left ventricular end-diastolic diameter; LAD: left atrial diameter; IVST: interventricular septal thickness; LVEF: left ventricular ejection fraction; LVH: left ventricular hypertrophy; NLR: neutrophil to lymphocyte ratio; Hb: hemoglobin; TCHO: total cholesterol; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; ARD/BSA: aortic root diameter indexed to BSA.

Data availability statement

Data available on request due to privacy/ethical restrictions.