Determinants and prognostic importance of cardiomegaly among new ESRD patients in the United States.

Purpose: Cardiomegaly is a radiographic abnormality of major prognostic importance in the general population. We explored the clinical correlations and mortality impact of cardiomegaly in new end-stage renal disease (ESRD) patients from the Dialysis Morbidity and Mortality Study Wave 2.

Methods: Radiographic data denoting the presence or absence of cardiomegaly were available for 97% (n=3908) of the entire cohort. Multivariate logistic regression explored relationships between potential uremic factors and known traditional cardiovascular disease (CVD) factors with cardiomegaly and Cox regression estimated the mortality risk associations over 2 years.

Results: The prevalence of cardiomegaly was 26%. Multivariate analysis identified: age (adjusted odds ratio [OR]=1.30 per 10 years older), black race (OR=1.33) diabetes (OR=1.26), hypertension (OR=1.28), tobacco use (OR=1.17), serum albumin (OR=1.36 per 1 g/dL lower), and extremes of body mass index (BMI) (OR=1.24 for BMI<21.1 and OR=1.10 for BMI>30.0 compared with referent [21.1-23.3 Kg/m2]) as significant correlates. The impact of cardiomegaly on mortality was greatest in the first 12 months (RR=1.56; CI, 1.33-1.83) and persisted for up to 2 years (RR=1.44; CI, 1.27-1.62). Interestingly, the likelihood of cardiomegaly was significantly lower for patients who received regular care during the pre-ESRD period (erythropoietin use [OR=0.79] and nephrology visits [OR=0.80 for > or =2 vs. less]).

Conclusions: Traditional CVD risk factors were the predominant correlates of cardiomegaly in new ESRD patients. Vigorous CVD risk factor reduction strategies and frequent specialist care during the pre-ESRD period may be beneficial in reducing the prevalence of cardiomegaly and attenuating its impact on survival.