Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Marwick, Thomas H.; Amann, Kerstin; Bangalore, Sripal; Cavalcante, João L.; Charytan, David M.; Craig, Jonathan C.; Gill, John S.; Mark, Daniel B.; Jardine, Alan G.; Landmesser, Ulf; Newby, L. Kristin; Herzog, Charles A.; Cheung, Michael; Wheeler, David C.; Winkelmayer, Wolfgang C.; Sarnak, Mark J.; Banerjee, Debasish; Briguori, Carlo; Chang, Tara I.; Chen, Chien Liang; deFilippi, Christopher R.; Ding, Xiaoqiang; Ferro, Charles J.; Gill, Jagbir; Gössl, Mario; Isbel, Nicole M.; Ishii, Hideki; Jardine, Meg; Kalra, Philip A.; Laufer, Günther; Lentine, Krista L.; Lobdell, Kevin W.; Lok, Charmaine E.; London, Gérard M.; Małyszko, Jolanta; Mark, Patrick B.; Marwan, Mohamed; Nie, Yuxin; Parfrey, Patrick S.; Pécoits-Filho, Roberto; Pilmore, Helen; Qunibi, Wajeh Y.; Raggi, Paolo; Rattazzi, Marcello; Rossignol, Patrick; Ruturi, Josiah; Sabanayagam, Charumathi; Shanahan, Catherine M.; Shroff, Gautam R.; Shroff, Rukshana; Webster, Angela C; Weiner, Daniel E.; Winther, Simon; Wiseman, Alexander C.; Yip, Anthony; Zarbock, Alexander

doi:10.1016/j.kint.2019.06.025

Cited by 100 publications

(109 citation statements)

References 92 publications

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“…It is undeniable that CKD has a significant impact on valvular defects. It affects the prognosis of people with these defects and has an impact on their course but it is not the main initiator of aortic stenosis and insufficiency [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Impaired kidney function contributes to vascular damage, increasing the concentration of inflammatory mediators and factors predisposing to the formation of calcifications with a simultaneous decrease in the concentration of calcination inhibitors (impaired calcium-phosphate balance). This leads to the calcination of vessel walls and also heart valves [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects

Kuźma

Małyszko

Bachórzewska−Gajewska

et al. 2020

Int Urol Nephrol

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Introduction Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy. Aim Analysis impact of CKD on long-term prognosis in patients with VHD. Material and methods The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ± 1454 days. Results The average age of the studied population was 66.75 (SD = 10.34), male gender was dominant 56% (N = 579). Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CKD occurred in 37.1% (N = 380) patients mostly with mitral stenosis (50%, N = 16) and those with severe MVI (44.8%, N = 94). During the observational period, 52.7% (N = 540) deaths were noted. Increased risk of mortality was associated mostly with age (OR: 1.02, 95% CI: 1.00–1.03, p < 0.001), creatinine (OR:1.27, 95% CI: 1.12–1.43, p < 0.001), CKD (OR: 1.30, 95% CI: 1.17–1.44, p < 0.001), reduced ejection fraction (EF) (OR: 0.98, 95% CI: 0.97–0.99, p = 0.01) and coexisting of AVS (OR: 1.19, 95% CI: 1.04–1.35, p = 0.01). Conclusions Mitral valve defects more often than aortic valve defects coexist with chronic kidney disease. Regardless of the stage, chronic kidney disease is an additional factor affecting the prognosis in patients with heart defects. Factors increasing the risk of death were age, creatinine concentration and reduced EF. The monitoring of renal function in patients with VHD should be crucial as well as the implementation of treatment at an early stage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects

Kuźma

Małyszko

Bachórzewska−Gajewska

et al. 2020

Int Urol Nephrol

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“…Unfortunately, there are not established pharmacological therapies to prevent or treat AS, and the only effective treatment is represented by aortic valve replacement. Surgical aortic valve replacement (SAVR) has been historically considered the gold standard of treatment for patients affected by AS, but the typical advanced age and high prevalence of comorbidities posed a relevant percentage of patients with AS at high or unacceptable surgical risk 1 . Transcatheter aortic valve replacement (TAVR) was conceived to offer a valuable alternative to inoperable patients with AS, but it has progressively shown to be superior to medical management and at least comparable to SAVR across the entire spectrum of surgical risk 2 .…”

mentioning

confidence: 99%

“…The reduction in aortic valve area is estimated to be 0.2 cm 2 /year in patients with CKD, twofold than reported in patients with preserved renal function, and this rate of progression is inversely proportional to the estimated GFR. Of note, these issues remain relevant also after aortic valve replacement 1 . Indeed, several observational studies showed how CKD patients have significantly higher rate of adverse events and increased mortality after surgical or percutaneous aortic valve replacement as compared with patients with normal renal function, and that patients with end‐stage renal disease (ESRD), with or without need for dialysis, are those presenting the worst prognosis 4 .…”

mentioning

confidence: 99%

“…Nevertheless, ESRD should not be deemed a marker of futility for TAVR. Some observational studies suggested a better 1‐year prognosis for ESRD patients undergoing SAVR or TAVR compared with those treated with balloon aortic valvuloplasty 1 . Unfortunately, the durability of aortic bioprosthesis in ESRD patients remains a totally uncharted territory, due to the limited survival of ESRD patients and their poor representation in prospective studies.…”

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confidence: 99%

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Transcatheter aortic valve replacement in patients with end‐stage renal disease: Is “better than nothing” good enough?

Chiarito

Mehran

2020

Cathet Cardio Intervent

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Key Points Patients with end‐stage renal disease (ESRD) have a three‐fold higher prevalence of aortic stenosis than patients with normal renal function, and are at increased risk of adverse events after surgical (SAVR) or transcatheter aortic valve replacement (TAVR). However, the optimal management of ESRD patients with concomitant aortic stenosis is still debated. This large observational, multicenter registry showed that in ESRD patients TAVR improves short term prognosis and reduces length and cost of hospital stay as compared with SAVR, although the rates of complications and mortality was still concerning. Specific efforts to refine the performance of TAVR in ESRD patients are urgently needed to improve outcome and quality of life in this growing population.

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A novel mouse model of calcific aortic valve stenosis

Qian,

Wang,

et al. 2024

Anim Models and Exp Med

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BackgroundCalcific aortic valve stenosis (CAVS) is one of the most challenging heart diseases in clinical with rapidly increasing prevalence. However, study of the mechanism and treatment of CAVS is hampered by the lack of suitable, robust and efficient models that develop hemodynamically significant stenosis and typical calcium deposition. Here, we aim to establish a mouse model to mimic the development and features of CAVS.MethodsThe model was established via aortic valve wire injury (AVWI) combined with vitamin D subcutaneous injected in wild type C57/BL6 mice. Serial transthoracic echocardiography was applied to evaluate aortic jet peak velocity and mean gradient. Histopathological specimens were collected and examined in respect of valve thickening, calcium deposition, collagen accumulation, osteogenic differentiation and inflammation.ResultsSerial transthoracic echocardiography revealed that aortic jet peak velocity and mean gradient increased from 7 days post model establishment in a time dependent manner and tended to be stable at 28 days. Compared with the sham group, simple AVWI or the vitamin D group, the hybrid model group showed typical pathological features of CAVS, including hemodynamic alterations, increased aortic valve thickening, calcium deposition, collagen accumulation at 28 days. In addition, osteogenic differentiation, fibrosis and inflammation, which play critical roles in the development of CAVS, were observed in the hybrid model.ConclusionsWe established a novel mouse model of CAVS that could be induced efficiently, robustly and economically, and without genetic intervention. It provides a fast track to explore the underlying mechanisms of CAVS and to identify more effective pharmacological targets.

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Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Abstract: The conference agenda, discussion questions, and plenary session presentations are available on the KDIGO website: https://kdigo.org/ conferences/controversies-conference-on-coronary-artery-valvulardisease/. 18 THM and MJS are primary co-authors.

Cited by 100 publications

References 92 publications

Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects

Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects

Transcatheter aortic valve replacement in patients with end‐stage renal disease: Is “better than nothing” good enough?

A novel mouse model of calcific aortic valve stenosis

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