Abstract 12731: Impact of Cardiac Valvular Calcification at Beginning Hemodialysis Therapy on Cardiovascular Outcome in Patients with End-stage Renal Disease

Abstract

Background: Cardiac valvular calcification is highly prevalent in patients with end-stage renal disease (ESRD), and its presence may be potentially linked with the increasing risk of systemic atherosclerotic events. We investigated whether the presence of calcified valve at just beginning of hemodialysis (HD) therapy could predict individual cardiovascular (CV) events in ESRD patients.

Methods: A total of 1785 consecutive ESRD patients were screened by echocardiography at beginning of HD therapy. Calcification was defined as bright echoes >1mm on one or more cusps of the cardiac valve. They were divided into three groups; those without valve calcification (group 0, n=783), those with calcification in a single (aortic or mitral) valve (group 1, n=651) and those with calcification in both valves (group 2, n=351), and were followed up for up to 10 years.

Results: During follow-up period (median 55months), 687 CV events [358 cardiac events (20.1%), 153 cerebrovascular events (8.6%) and 176 peripheral arterial events (9.9%)] occurred, and 536 patients (30.0%) died including 234 CV death (13.1%). In the group 0, 1 and 2, 10-year event-free rates were 67.6%, 58.6% and 40.9% for cardiac events (p<0.0001), 85.0%, 84.9% and 72.4% for cerebrovascular events (p=0.0008), 83.4%, 82.9% and 70.5% for peripheral arterial events (p<0.0001), and 56.6%, 48.0% and 29.1% for composite endpoint of CV events (p<0.0001), respectively. Similarly, survival rates were 82.8%, 77.1% and 62.6% for CV mortality, and 66.3%, 54.5% and 39.8% for all-cause mortality, respectively (p<0.0001 in both). Even after adjustment, valvular calcification was an independent predictor for all endpoints (Table).

Conclusion: The presence of calcified valves at beginning of HD therapy could predict not only cardiac events but also cerebrovascular and peripheral artery events, and might be associated with systemic atherosclerotic events in ESRD patients.