Prevalence and Outcomes of Left‐Sided Valvular Heart Disease Associated With Chronic Kidney Disease

Abstract

BackgroundChronic kidney disease (CKD) is an adverse prognostic marker for valve intervention patients; however, the prevalence and related outcomes of valvular heart disease in CKD patients is unknown.Methods and ResultsIncluded patients underwent echocardiography (1999–2013), had serum creatinine values within 6 months before index echocardiogram, and had no history of valve surgery. CKD was defined as diagnosis based on the International Classification of Diseases, Ninth Revision or an estimated glomerular filtration rate <60 mL/min per 1.73 m2. Qualitative assessment determined left heart stenotic and regurgitant valve lesions. Cox models assessed CKD and aortic stenosis (AS) interaction for subsequent mortality; analyses were repeated for mitral regurgitation (MR). Among 78 059 patients, 23 727 (30%) had CKD; of these, 1326 were on hemodialysis. CKD patients were older; female; had a higher prevalence of hypertension, hyperlipidemia, diabetes, history of coronary artery bypass grafting/percutaneous coronary intervention, atrial fibrillation, and heart failure ≥mild AS; and ≥mild MR (all P<0.001). Five‐year survival estimates of mild, moderate, and severe AS for CKD patients were 40%, 34%, and 42%, respectively, and 69%, 54%, and 67% for non‐CKD patients. Five‐year survival estimates of mild, moderate, and severe MR for CKD patients were 51%, 38%, and 37%, respectively, and 75%, 66%, and 65% for non‐CKD patients. Significant interaction occurred among CKD, AS/MR severity, and mortality in adjusted analyses; the CKD hazard ratio increased from 1.8 (non‐AS patients) to 2.0 (severe AS) and from 1.7 (non‐MR patients) to 2.6 (severe MR).ConclusionsPrevalence of at least mild AS and MR is substantially higher and is associated with significantly lower survival among patients with versus without CKD. There is significant interaction among CKD, AS/MR severity, and mortality, with increasingly worse outcomes for CKD patients with increasing AS/MR severity.

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

“…1 The prevalence increased in parallel with the progression to more advanced kidney disease ( Figure 2). 1 In particular, aortic stenosis progressed more rapidly among CKD patients; the decline in AV area was estimated to progress at w0.2 cm 2 per year in patients with CKD, compared with w0.1 cm 2 per year among patients without CKD. 7 The 2-year survival of patients with CKD who had valvular disease was 72% compared with 86% in the general population.…”

“…This association with VHD is prognostically important, being associated with poor outcomes and higher mortality. 1 The 5-year mortality rate among patients with at least mild aortic stenosis or mitral regurgitation is more than 50% greater than in persons without CKD. 1 Epidemiology CKD.…”

“…1 The 5-year mortality rate among patients with at least mild aortic stenosis or mitral regurgitation is more than 50% greater than in persons without CKD. 1 Epidemiology CKD. The first detectable stage of VHD involvement in CKD is calcification.…”

“…6 More specifically, functional evidence of aortic stenosis (as opposed to aortic calcification) was present in 9.5% of patients with CKD, compared with 3.5% of the general population (Figure 1 1 ), with similar patterns for mitral regurgitation (43% vs. 24%), mitral stenosis (2% vs. 1%), and aortic regurgitation (19% vs. 10%). 1 Even when taking account of age, year of echocardiogram, race, sex, history of hyperlipidemia, hypertension, congestive heart failure, diabetes mellitus, and prior coronary revascularization, patients with CKD had a 1.2-to 1.3-fold increased odds of aortic stenosis and 1.3-to 1.8-fold odds of mitral regurgitation. 1 The prevalence increased in parallel with the progression to more advanced kidney disease ( Figure 2).…”

“…1 Even when taking account of age, year of echocardiogram, race, sex, history of hyperlipidemia, hypertension, congestive heart failure, diabetes mellitus, and prior coronary revascularization, patients with CKD had a 1.2-to 1.3-fold increased odds of aortic stenosis and 1.3-to 1.8-fold odds of mitral regurgitation. 1 The prevalence increased in parallel with the progression to more advanced kidney disease ( Figure 2). 1 In particular, aortic stenosis progressed more rapidly among CKD patients; the decline in AV area was estimated to progress at w0.2 cm 2 per year in patients with CKD, compared with w0.1 cm 2 per year among patients without CKD.…”