So088burden of Valvular Heart Disease in Haemodialysis Recipients

Abstract

Background and Aims Valvular heart disease (VHD) is highly prevalent in maintenance haemodialysis patients. This high prevalence is associated with poor outcomes and higher mortality [Samad et al., Journal of the American Heart Association, 6 (10), (2017)]. Previous large studies found VHD prevalence between 14% and 16% among prevalent haemodialysis patients [2018 USRDS Annual Data Report | Vol 2] [Hickson et al., Journal of the American College of Cardiology, 67(10), (2016)]. KDIGO consensus group identified several evidence gaps where research is necessary in order to improve our understanding of diagnosis and management of VHD in this population [Marwick et al., Kidney international, 96 (4), (2019)]. The aim of our study is to assess the burden of VHD in a large cohort of haemodialysis recipients in one center in the United Kingdom (UK). Method This is a retrospective cross-sectional evaluation of valvular heart disease in prevalent haemodialysis patients. Prevalent haemodialysis recipients were defined as patients established on haemodialysis for ≥ 3 months. Echocardiographic data was collected for all patients. Patients were considered to have VHD if they had significant aortic (AVD) or mitral valve disease (MVD) based on standard echocardiographic criteria. These valvular diseases are classified as mild, moderate or severe. Here, we report some descriptive statistics from our data. Results The study group includes 544 prevalent haemodialysis patients. Mean age was 62 years (SD 15.28), 40% females and 60% were males. Median dialysis vintage was 1.9 years (IQR 1, 3.2) [Range: 0.2, 10.2]. 14 % of patients received home-based hemodialysis and 86% received in-center dialysis. 30% of patients were actively awaiting a transplant. A total of 1155 echocardiography studies were reviewed. Of the 425 patients who had an echocardiogram; 34% (n=143) had evidence of VHD as defined above. Significant AVD was identified in 18% of patients (n=78). The dominant lesion was aortic regurgitation in 11%, and aortic stenosis in 7% of patients. 20% of patients (n=85) had significant MVD with mitral valve stenosis in 0.7% of patients (n=3) and mitral regurgitation in 18% of patients. 5% of patients had cardiothoracic intervention (n=21) for valvular heart disease, which included aortic valve replacement (n=9), transcatheter aortic valve implantation (TAVI) (n=9), and mitral valve replacement (n=3). Conclusion We found that at least one third (34%) of patients in this cohort had significant VHD- higher than the previously published figures. The numbers are likely to be higher, if echocardiogram information was available for all patients in the study. Timely echocardiographic studies and follow-up imaging for those with established disease are essential to identify patients with significant VHD, in order to establish impact of disease on both dialysis delivery and patient symptoms.