Cross-Sectional Association of Kidney Function with Valvular and Annular Calcification

Fox, Caroline S.; Larson, Martin G.; Vasan, Ramachandran S.; Guo, Chao-Yu; Parise, Helen; Levy, Daniel; Leip, Eric; O’Donnell, Christopher J.; D’Agostino, Ralph B.; Benjamin, Emelia J.

doi:10.1681/asn.2005060627

Cited by 164 publications

(88 citation statements)

References 48 publications

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“…In the clinical course of chronic kidney disease, heart valve calcification can be seen even before initiation of HD. 27,28 The results in MultiEthnic Study of Atherosclerosis showed the prevalence of AVC was higher than that of MVC in patients with chronic kidney disease not requiring HD. 28 In our patients with mean HD duration of 95 months, the prevalence of AVC and MVC was 75.0 and 51.7%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Differences in associated factors between aortic and mitral valve calcification in hemodialysis

et al. 2010

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Increased prevalence of aortic and mitral valve calcification has been reported in patients on hemodialysis, but it remains unknown whether aortic and mitral valve calcification arise from similar pathogenesis. We detected heart valve calcification using two-dimensional echocardiography, and we related valve calcification to various clinical parameters in patients treated with hemodialysis three times a week for more than 1 year. In 112 patients (77 men and 35 women, age 67±10 years, duration on hemodialysis 95 ± 67 months), aortic and mitral valve calcification were observed in 84 (75.0%) and 58 (51.7%) patients, respectively. Aortic valve calcification was associated with increased age, higher serum calcium, lower serum albumin, lower total cholesterol and higher high-sensitivity C-reactive protein. Multivariate analysis showed that increased age and higher serum calcium were independently associated with aortic valve calcification. Conversely, mitral valve calcification was associated with increased age, higher high-sensitivity C-reactive protein and higher serum b 2 -microglobulin, but not with higher serum calcium. In multivariate analysis, increased age and higher serum b 2 -microglobulin were independently associated with mitral valve calcification. Serum b 2 -microglobulin was associated with longer duration on hemodialysis, malnutrition inflammation (lower serum albumin and higher high-sensitivity C-reactive protein) and dyslipidemia. Considering the results in previous studies showing that the distribution of b 2 -microglobulin amyloid deposition was consistent with that of tissue calcification in patients on hemodialysis, b 2 -microglobulin may have pathogenic roles in valve calcification.

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Section: Discussionmentioning

confidence: 99%

Differences in associated factors between aortic and mitral valve calcification in hemodialysis

et al. 2010

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“…32 In addition, end-stage renal disease has long been known to be a risk factor for the presence and progression of aortic stenosis, 40,41 though mild to moderate renal disease does not appear to be significantly associated with aortic valve calcification. 42 One study recently has identified metabolic syndrome as an additional risk factor for valve calcification. 43 The similarities between risk factors for atherosclerosis and calcific aortic valve disease have led to the hypothesis that calcific aortic valve disease is primarily a manifestation of atherosclerosis.…”

Section: Epidemiologymentioning

confidence: 99%

Pathogenesis of Calcific Aortic Valve Disease

O’Brien

2006

ATVB

254

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Background-Over the past 10 to 15 years, calcific aortic valve disease, which includes aortic sclerosis and aortic stenosis, has come to be recognized as an active process, based on: (1) epidemiologic studies demonstrating associations of specific risk factors with increased prevalence or rate of progression of aortic valve disease; (2) identification, in valve lesions, of histopathologic features of chronic inflammation, lipoprotein deposition, renin-angiotensin system components, and molecular mediators of calcification; and (3) identification of cell-signaling pathways and genetic factors that may participate in valve disease pathogenesis. These studies will be reviewed and organized into a proposed global hypothesis for the pathogenesis of calcific aortic valve disease. Key Words: aortic valve disease Ⅲ calcification Ⅲ lipoproteins Ⅲ matrix Ⅲ angiotensin II C alcific aortic valve disease is identified by thickening and calcification of the aortic valve leaflets in the absence of rheumatic heart disease. It is divided, on a functional basis, into aortic sclerosis, in which the leaflets do not obstruct left ventricular outflow, and aortic stenosis, in which obstruction to left ventricular outflow is present. Aortic sclerosis is present in more than 25% of patients over age 65 1 and is associated with a 50% increase risk of cardiovascular events. 2 Aortic stenosis is present in 2% to 5% of very elderly patients, 1,3 is the second most common indication for cardiac surgery, 4 and carries an 80% 5-year risk of progression to heart failure, valve replacement, or death. 5 Though the disease is associated with substantial clinical consequences, there currently is no effective therapy for the disease other than surgical aortic valve replacement.The lack of medical therapies for calcific aortic valve disease can be traced to at least two important issues, one intellectual, the other practical. The first was the long-held notion that calcific aortic valve disease was a "degenerative," and therefore unmodifiable, condition. 6 However, more recent studies have demonstrated convincingly that calcific aortic valve lesions have many features characteristic of an active pathobiological process, including chronic inflammation, 7-9 lipoprotein deposition, 10 -12 active calcification, [13][14][15][16][17][18] and renin-angiotensin system activation. 19,20 These features are present in both trileaflet and bileaflet aortic valve lesions. 21 Also, an emerging body of literature is investigating how genetic factors might influence disease development. [22][23][24][25] The second issue is that, for many years, there were no animal models that faithfully replicated the key histological features of the disease. Recently, rabbit models been developed, 16,26,27 with that of Rajamannan and colleagues already providing a number of novel insights. 16 -18,28,29 In particular, these models have implicated the Wnt 18 and Runx2/ Cbfa1 16,17,27 signaling pathways in disease pathogenesis. Only very recently has a purported mouse model of calcif...

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“…In the study of Sharma et al MVC predicted all-cause mortality, cardiovascular mortality and morbidity in ESRD patients [4]. MVC is common in the setting of ESRD [6,11,15,16] and in patients with chronic kidney disease before the onset of ESRD [17]. More recently, Fox et al have demonstrated that in the community, chronic kidney disease is associated with MVC before the onset of ESRD [17].…”

Section: Discussionmentioning

confidence: 99%

Cardiac valve calcifications and predictive parameters in hemodialysis patients

et al. 2007

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AbstractCardiac valvular calcification is frequent among hemodialysis (HD) patients. The presence of valvular calcification can help identify HD patients with a higher risk for cardiovascular diseases. Our aim was to determine the prevalence of valvular calcification (VC) in our maintenance hemodialysis (HD) population and to examine some possible etiologic factors for its occurrence. We studied forty-four patients on hemodialysis (23 women and 21 men; mean age 57 ± 18 year; mean HD duration 34 ± 28 months). Valvular calcification (VC) was observed in 21 patients (48%). Of these patients, 6 patients (13%) had mitral valvular calcification, 9 patients (20%) had aortic valvular calcification, and 6 patients (13%) had calcification of both valves. The patients with VC were older than patients without VC (66±14 vs. 50±18). The patients with aortic calcification had longer HD duration than others (48±29 vs. 27±24 months). Patients with VC had higher systolic and diastolic blood pressures than patients without VC. The patients with mitral calcification had higher C-reactive protein (CRP) levels (14 ± 13 vs. 7 ± 7). No significant differences were found with respect to calcium, phosphorus, parathyroid hormone, alkaline phosphatase and mean Ca × P product. Our study confirmed that there is an increased prevalence of VC in HD patients. Age is a risk factor for cardiac VC in HD patients. Longer HD duration was associated with aortic valve calcification. In addition, elevated level of CRP is associated with mitral valve calcification in HD patients.

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Cross-Sectional Association of Kidney Function with Valvular and Annular Calcification

Cited by 164 publications

References 48 publications

Differences in associated factors between aortic and mitral valve calcification in hemodialysis

Differences in associated factors between aortic and mitral valve calcification in hemodialysis

Pathogenesis of Calcific Aortic Valve Disease

Cardiac valve calcifications and predictive parameters in hemodialysis patients

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