Open Access Highly Accessed Research article

Incidental findings on cardiac computed tomography in incident hemodialysis patients: the predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study

Bernard G Jaar1234*, Lili Zhang5, Svetlana V Chembrovich6, Stephen M Sozio13, Tariq Shafi13, Julia J Scialla7, Gordon F Tomaselli1, Joao A C Lima1, Wen Hong Linda Kao123, Rulan S Parekh128 and Lucy A Meoni139

Author Affiliations

1 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

3 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA

4 Nephrology Center of Maryland, Baltimore, MD, USA

5 Jacobi Medical Center, Bronx, NY, USA

6 Greater Baltimore Medical Center, Baltimore, MD, USA

7 Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA

8 Departments of Pediatrics, Hospital for Sick Children and Medicine, University Health Network, University of Toronto, Ontario, Canada

9 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

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BMC Nephrology 2014, 15:68  doi:10.1186/1471-2369-15-68

Published: 1 May 2014



This is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics.


We performed a cross-sectional analysis in the Predictors of Arrhythmic and Cardiovascular Events in End-Stage Renal Disease (PACE) study, a prospective cohort study on incident hemodialysis patients. Non-cardiac structures in the cardiac CT scan were reviewed and evaluated. The type and frequencies of non-cardiac incidental CT findings were summarized. Univariate and multivariate logistic regression were performed to analyze the associations between gender, older age, obesity, history of cardiovascular disease (CVD), smoking status, history of chronic pulmonary disease and history of cancer with presence of any incidental CT findings and, separately, pulmonary nodules.


Among the 260 participants, a total of 229 non-cardiac incidental findings were observed in 145 participants (55.8% of all participants). Of these findings, pulmonary nodules were the most common incidental finding (24.2% of all findings), and 41.3% of them requiring further follow-up imaging per radiology recommendation. Vascular and gastrointestinal findings occurred in 11.8% and 15.3% of participants, respectively. Participants 65 years or older had a higher odds of any incidental findings (Odds Ratio (OR) =2.55; 95% Confidence Intervals (CI) 1.30, 4.99) and pulmonary nodules (OR = 4.80; 95% CI 2.51, 9.18). Prior history of CVD was independently and significantly associated with any incidental findings (OR = 2.00; 95% CI 1.19, 3.40); but not with the presence of pulmonary nodules.


We demonstrate that the prevalence of incidental findings by cardiac CT scanning is extremely high among patients on hemodialysis. Further investigations to follow-up on the high occurrence of incidental findings during our research study and potentially clinical studies raises important practical, ethical and medico-legal issues that need to be carefully considered in research projects using imaging studies.

Incidental findings; Cardiac; Computed tomography; Hemodialysis; Prevalence; Pulmonary nodule