Predictive Value of Mitral and Aortic Valve Sclerosis for Survival in End-Stage Renal Disease on Continuous Ambulatory Peritoneal Dialysis

Abstract

To determine whether mitral valve or anular sclerosis or calcification (MC) is associated with reduced survival in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), 53 CAPD patients were followed with echocardiography and Doppler echocardiography over 35 months. Both nonsurvivors and survivors with MC had higher systolic blood pressure before CAPD and calcium-phosphorus products during CAPD treatment than patients without MC (p < 0.05). Serum calcium and phosphorus concentrations, alkaline phosphatase and parathyroid hormone activities were higher in nonsurvivors and survivors with than without MC (p > 0.05). Left ventricular end-diastolic and end-systolic volumes were greater (p < 0.01), ejection fractions were smaller (p < 0.05) in nonsurvivors with than without MC, but not in survivors with versus without MC. Severe MC and grade III mitral valve regurgitation were more frequent in nonsurvivors than in survivors (p < 0.03). No valvular stenoses were found. It is concluded that the development of MC is favored by long-standing predialysis arterial hypertension and by high calcium-phosphorus products during CAPD. Nonsurvivors with MC are characterized by reduced systolic left ventricular function or severe valvular lesions. A close cardionephrologic cooperation is necessary to improve the survival of CAPD patients with these risk factors.

Aortic and Mitral Annular Calcifications Are Predictive of All-Cause and Cardiovascular Mortality in Patients With Type 2 Diabetes

“…Notably, the combined presence of AVS and MAC was more strongly associated with an increased risk of all-cause and CVD mortality than the presence of either item alone. Collectively, the results of this study complement and expand previous observations on the value of AVS and MAC for predicting mortality both in the general population and in other nondiabetic high-risk patient populations (1,4–9,18). …”

“…However, AVS shows epidemiologic and histopathologic similarities to coronary atherosclerosis (2,3). In addition, recent large prospective studies have suggested a strong association between AVS and cardiovascular disease (CVD) outcomes both in the general population (1,4–6) and in nondiabetic high-risk patient populations such as patients with hypertension (7), coronary artery disease (8), and chronic kidney disease (9). …”

Cardiac function and structure in patients with chronic renal failure

“…Mesodiastolic or presystolic murmurs may be ascribed to functional stenosis of the mitral valve. Systematic echocardiography in adult patients with ESRD has shown that valvular disease is observed mainly in the presence of cardiomegaly and overhydration in association with left atrial and ventricular dilatation [6]. The functional nature of mitral and tricuspid regurgitation was recently proven by disappearance of these lesions after intensified ultrafiltration in hemodialysis patients [7].…”

Cardiovascular disease as a late complication of end-stage renal disease in children

“…Left ventricular hypertrophy (LVH), enhanced aortic valve calcification, and increased wall stiffening and intima media thickening of the large arteries have all been recognized as independent risk factors for acute death in these patients [1,2,3,4]. Until recently, there were only limited data on cardiovascular disease in children with ESRD.…”