Abstract 11633: Association of Cardiac Valve Calcification and C-Reactive Protein with Cardiovascular and All-Cause Mortality in End-Stage Renal Disease Patients - 10-Year Follow-Up Study from Induction of Hemodialysis Therapy
Background: Cardiac valve calcification is frequently seen in patients with end-stage renal disease (ESRD), and may potentially reflect systemic atherosclerosis. Serum C-reactive protein (CRP) is also reported to predict future cardiovascular (CV) events. We investigated the association of cardiac valve calcification, CRP and their joint role with prediction of mortality in patients on hemodialysis (HD).
Methods: A total of 1,290 consecutive patients who electively started HD therapy were screened by echocardiography. Patients were divided into 3 groups; those without valve calcification (NC group, n=548), those with calcification in a single (aortic or mitral) valve (SC group, n=487) and those with calcification in both valves (BC group, n=255). They were also divided into tertiles according to serum CRP levels; T1: <0.9 mg/l, T2: ≥0.9 to >4.9mg/l and T3: ≥4.9mg/l, respectively. They were followed up for up to 10 years.
Results: Serum CRP levels were 4.0±6.7mg/l, 6.8±9.9mg/l and 7.2±9.8mg/l in the NC, SC and BC group, respectively (p<0.0001), and were independently associated to valve calcification (Odds ratio 1.13, 95%CI 1.06-1.21, p=0.0003). Adjusted hazard ratio (HR) of valve calcification was 2.64 (95%CI 1.53-4.56, p=0.0023 for group BC vs. NC) for CV mortality and 1.86 (95%CI 1.30-2.67, p<0.0001 for group BC vs. NC) for all-cause mortality. Similarly, adjusted HR of elevated CRP levels was 3.09 (95%CI 1.54-6.16, p=0.0050 for T3 vs. T1) for CV mortality and 2.44 (95%CI 1.64-3.64, p<0.0001 for T3 vs. T1) for all-cause mortality. In the joint setting of valve calcification and CRP, the risk of CV and all-cause mortality was 6.4-fold (p=0.0073) and 3.6-fold (p<0.0001) in the BC group with T3 of CRP compared with the NC group with T1 of CRP even after adjustment, respectively (Figure).
Conclusion: Cardiac valve calcification and elevated CRP levels were closely linked, and interactively increased risk of mortality in ESRD patients who started HD therapy.
- © 2011 by American Heart Association, Inc.