Predicting risk of mortality in dialysis patients: prognostic value of a simple chest x-ray

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Bohn, Ethan
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Patients with kidney failure on dialysis are at high risk for cardiovascular disease and premature death in aggregate. Individual patient risk, however, varies widely. Improved ascertainment of individual risk could inform decisions about patient management and counselling. Since the majority of mortality of patients is driven by cardiovascular (CV) causes, CV risk factors such as heart size and aortic calcification are plausible prognostic markers. The objective of this study was to assess the value of simple, chest X-ray derived measures of cardiac size (Cardiothoracic Ratio) and vascular calcification (Aortic Arch Calcification), in predicting death in a prevalent cohort of hemodialysis (HD) patients. Employing the Manitoba Renal Database, all patients starting dialysis in Manitoba from 2000-2010 and who received a chest X-ray were identified. Cardiothoracic ratio and aortic calcification values were determined by two independent reviewers for 824 prevalent patients. The goals of the student were to 1) learn how to use a medical database 2) develop clinical chest X-ray reading skills and 3) become familiar with and use appropriate statistical tools to determine whether cardiothoracic ratio, aortic arch calcification, or both, were predictors of mortality, and whether they improved upon simpler prognostic models.