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Multicenter Study
. 2011 Aug;6(8):1990-5.
doi: 10.2215/CJN.01140211. Epub 2011 Jun 23.

All-cause mortality in hemodialysis patients with heart valve calcification

Paolo Raggi  1 , Antonio Bellasi, Christopher Gamboa, Emiliana Ferramosca, Carlo Ratti, Geoffrey A Block, Paul Muntner
Affiliations
Multicenter Study

All-cause mortality in hemodialysis patients with heart valve calcification

Paolo Raggi et al. Clin J Am Soc Nephrol. 2011 Aug.

Abstract

Background and objectives: Calcification of the mitral and aortic valves is common in dialysis patients (CKD-5D). However, the prognostic significance of valvular calcification (VC) in CKD is not well established.

Design, setting, participants, & measurements: 144 adult CKD-5D patients underwent bidimensional echocardiography for qualitative assessment of VC and cardiac computed tomography (CT) for quantification of coronary artery calcium (CAC) and VC. The patients were followed for a median of 5.6 years for mortality from all causes.

Results: Overall, 38.2% of patients had mitral VC and 44.4% had aortic VC on echocardiography. Patients with VC were older and less likely to be African American; all other characteristics were similar between groups. The mortality rate of patients with calcification of either valve was higher than for patients without VC. After adjustment for age, gender, race, diabetes mellitus, and history of atherosclerotic disease, only mitral VC remained independently associated with all-cause mortality (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.03 to 2.91). Patients with calcification of both valves had a two-fold increased risk of death during follow-up compared with patients without VC (HR, 2.16; 95% CI, 1.14 to 4.08). A combined CT score of VC and CAC was strongly associated with all-cause mortality during follow-up (HR for highest versus lowest tertile, 2.21; 95% CI, 1.08 to 4.54).

Conclusions: VC is associated with a significantly increased risk for all-cause mortality in CKD-5D patients. These findings support the use of echocardiography for risk stratification in CKD-5D as recently suggested in the Kidney Disease Improving Global Outcomes guidelines.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier graph of all-cause mortality risk for patients with and without aortic valve calcification.
Figure 2.
Figure 2.
Kaplan–Meier graph of all-cause mortality risk for patients with or without mitral-valve calcification.
See this image and copyright information in PMC

References

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