Abstract 17578: Predictive values of Cardiac Valvular Calcification and Protein-Energy Wasting in Cardiovascular Outcome in End-Stage Renal Disease Patients at Starting Hemodialysis Therapy
Introduction: Cardiac valvular calcification, frequently seen in patients with end-stage renal disease (ESRD), potentially reflects systemic atherosclerosis. Protein-energy wasting (PEW) or malnutrition is also prevalent, and associated with increasing cardiovascular (CV) risk in this population.
Hypothesis: There may be the association of valvular calcification, PEW and their joint role with prediction of CV events and mortality in ESRD patients at starting hemodialysis (HD) therapy.
Methods: A total of 1,542 ESRD patients who electively started HD therapy were screened by echocardiography. Patients were divided into 3 groups according to the number of calcified valves: those without valve calcification (group 0, n=708), those with calcification in a single (aortic or mitral) valve (group 1, n=555) and those with calcification in both valves (group 2, n=279). Patients were also divided into tertiles according to geriatric nutritional risk index (GNRI) levels as a simplified marker of PEW state: tertile 1 (T1): 95.2. They were followed up for up to 10 years.
Results: The GNRI levels were 92.6±9.6, 91.0±9.5 and 89.6±9.3 in group 0, 1 and 2, respectively (p<0.0001), and were closely associated to valve calcification (adjusted odds ratio 0.98, 95%CI 0.97-0.99, p=0.0016). Adjusted hazard ratio (HR) of valvular calcification was 1.41 (95%CI 1.10-1.81, p=0.0069 for group 2 vs. 0) for CV events and 1.94 (95%CI 1.23-3.07, p=0.0045 for group 2 vs. 0) for CV mortality, respectively. Similarly, adjusted HR of declined GNRI levels was 1.39 (95%CI 1.09-1.77, p=0.0087 for T1 vs. T3) for CV events and 1.79 (95%CI 1.15-2.81, p=0.010 for T1 vs. T3) for CV mortality, respectively. In the combined setting of valvular calcification and GNRI, the risk of CV events and mortality was 1.95-fold (p=0.0054) and 3.12-fold (p=0.0056) in the group 2 with T1 of GNRI compared with the group 0 with T3 of GNRI after adjustment for other confounders, respectively (Figure).
Conclusions: Cardiac valvular calcification and PEW state were closely linked. The combine evaluation of these variables was useful for risk stratification to predict CV prognosis in ESRD patients who just started HD therapy.
Author Disclosures: H. Ishii: Speakers Bureau; Modest; Astellas Pharma Inc., Daiichi Sankyo Co., Ltd., and Otsuka Pharma Inc.. D. Kamoi: None. T. Aoyama: None. H. Takahashi: None. T. Sakakibara: None. T. Murohara: Speakers Bureau; Significant; Astellas Pharma Inc, Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K.K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K.,.
- © 2014 by American Heart Association, Inc.