Accelerated Progression of Calcific Aortic Stenosis in Dialysis Patients

Abstract

Background: Abnormalities of the aortic valve occur with increased frequency in patients with renal failure and may contribute to the observed excess cardiovascular mortality. Little data exist on the rate at which aortic stenosis progresses in this patient group. Methods: A retrospective case-control study was designed to compare the rate of progression of aortic stenosis in dialysis patients with that in sex-matched controls. Dialysis patients with aortic stenosis were identified by a search of the echocardiography database. Twenty-eight dialysis patients were compared to 56 sex-matched controls, all of whom had aortic stenosis on at least two echocardiograms 6 months apart. Changes in mean and peak transvalvular gradient as well as valve area were calculated from echocardiographic data and compared. Results: Aortic stenosis progressed more rapidly in the dialysis patients than in the controls when measured by change in valve area (–0.19 vs. –0.07 cm²/year; p < 0.001) and change in peak transvalvular gradient (6.5 vs. 3.9 mm Hg/ year; p = 0.04). There was also a trend towards more rapid progression of mean transvalvular gradient (4.9 vs. 2.5 mm Hg/year; p = 0.052). On multivariate linear regression analysis, only end-stage renal failure (p = 0.02) and baseline valve area (p = 0.04) predicted accelerated progression of aortic stenosis. Conclusions: Aortic stenosis progressed more rapidly in the presence of renal failure. The time frames for review and operation in dialysis patients should be shorter than for the general population.

Higher visit-to-visit intra-dialytic blood pressure is associated with the progression of aortic valve stenosis in chronic hemodialysis patients

“…To the best of our knowledge, this is the first study to demonstrate that mean visit-to-visit intra-dialytic BP is associated with the progression of AS in CHD patients. The mean yearly progression of AS was 0.18 ± 0.20 cm 2 in our population, which is similar to other studies reporting an accelerated AS progression in CHD patients compared with control patients (0.19 vs. 0.07 cm 2 [7] or 0.14 ± 0.13 vs. 0.06 ± 0.09 cm 2 [8]). We previously reported that SBP accelerates the progression of AS in the same population [11].…”

“…In CHD patients, aortic valve stenosis (AS), which is associated with cardiovascular atherosclerosis and adverse outcome [3][4][5], is the most important valvular complication contributing to poor prognosis because of its higher prevalence and more rapid progression compared with the general population [6][7][8]. Therefore, the identification of non-traditional and modifiable risk factors affecting AS progression in CHD patients could have a beneficial effect for secondary prevention.…”

Impact of Chronic Kidney Disease on the Presence and Severity of Aortic Stenosis in Patients at High Risk for Coronary Artery Disease

“…There are significant similarities in clinical risk factors and histopathological alterations between calcific aortic valve disease and coronary atherosclerosis [3]. It is also widely recognized that both cardiac and renal diseases are commonly present in the same patient, and the presence of chronic kidney disease (CKD) further accelerates and amplifies the process of aortic valve calcification via multiple pathways, such as altered mineral metabolism, inflammation, oxidative stress, and pressure and volume overload [4,5]. Previous studies have demonstrated an association between end-stage renal disease and calcific cardiovascular disease, especially in patients on dialysis [6-9]; however, less is known about the impact of early stage CKD on the prevalence and severity of calcific aortic valve disease.…”

Impact of inflammation and oxidative stress on vascular calcifications in chronic kidney disease

“…The process of vascular and valvular calcification is accelerated and amplified in patients with chronic kidney disease (CKD) [8,9]. As in the general population, the calcifications observed in CKD patients also appear to indicate a poor prognosis in terms of overall survival and cardiovascular morbidity [10,11,12].…”