Abstract 2656: High Prevalence of Cardiac Valve Calcification and its Association with Future Cardiovascular Morbidity and Mortality in End-stage Renal Disease Patients at Beginning of Hemodialysis Therapy
Background: Although vascular or tissue calcification is a frequent complication in patients with end-stage renal disease (ESRD), there are limited data on its prevalence in ESRD patients at inducting hemodialysis (HD) therapy and the association with future cardiovascular (CV) events. The aim of this study was to clarify the prevalence and predictive power of cardiac valve calcification for future cardiac events in ESRD patients at inducting HD.
Methods: Consecutive 601 ESRD patients (male: 64%, age: 63±13years, diabetes: 56%) were introduces into HD therapy, and echocardiography was performed in all patients within 1 month after initiating HD. They were divided into 3 groups; patients without valve calcification (NC group), patients with single (aortic or mitral) valve calcification (SC group) and patients with both valves calcification (BC group). They were followed-up for 7 years.
Results: Valve calcification was seen in 334 patients (56%) [159 patients (27%): aortic valve only, 58 (10%): mitral valve only, and 117 (20%): both valves]. During follow-up period (40±32months), 236 patients had CV events (36%) and 116 (18%) died. Upon Kaplan-Meier analysis, CV event-free survival rate for 7 years was 63% in the NC group, 52% in the SC group and 30% in the BC group (p<0.0001). CV survival rate was 94%, 79% and 68%, and all-cause survival was 82%, 60% and 49% in the NC, SC and BC group, respectively (both p<0.0001). Cox proportional hazards models showed that the presence of valve calcification was a significant predictor of CV events, CV mortality and all-cause mortality even after adjustment for other CV risk factors including male, age, duration of HD, traditional risk factors, BMI, previous CVD, hemogrobin, albumin, HDL, LDL and C-reactive protein (Table⇓).
Conclusion: Cardiac valve calcification was seen in over half of ESRD patients even at inducting HD, and might be strongly associated with future CV morbidity and mortality.