The influence of cardiac valvular calcification on all-cause and cardiovascular mortality in maintenance hemodialysis patients
- 1 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Urology and Nephrology
- Vol. 52 (5), 943-951
- https://doi.org/10.1007/s11255-020-02448-4
Abstract
Objective To investigate the effect of cardiac valve calcification (CVC) on all-cause and cardiovascular mortality in maintenance hemodialysis (MHD) patients. Methods A retrospective cohort study was conducted in 183 long-term hemodialysis patients with complete follow-up data from January 1, 2012, to December 30, 2015. The baseline data between CVC and non-CVC groups were compared. Kaplan–Meier method was used to analyze all-cause and cardiovascular mortality. The effect of CVC on prognosis was analyzed using the Cox proportional hazard regression model and subgroup analysis. Results Among 183 patients under hemodialysis, 104 (56.8%) were males, with an average age of 56.1 ± 17.0 years and 68 (37.2%) were complicated with valvular calcification. The median follow-up period was 30.8 months. All-cause and cardiovascular mortality were 50% vs. 14.8% and 25% vs. 7.0% in the CVC and non-CVC groups, respectively (P < 0.05). Kaplan–Meier indicated that differences in all-cause and cardiovascular mortality were statistically significant between the two groups (P < 0.001). Cox regression analysis showed that CVC significantly increased all-cause (hazards ratio [HR] 2.161 [1.083–4.315]) and cardiovascular mortality (3.435 [1.222–9.651]) after adjusting for multiple factors. Meanwhile, CVC also increases the incidence of new-onset cardiovascular events. Subgroup analysis revealed that all-cause and cardiovascular mortality were significantly higher in patients with aortic valve calcification (AVC) than in patients with mitral valve calcification (MVC). Multivariate calibration showed that AVC increased the risk of cardiovascular death (HR 5.486 [1.802–16.702]) (P < 0.05), whereas MVC did not. By further comparing the echocardiographic data of the two groups, the incidence of LVH and pulmonary hypertension in the AVC group was significantly higher than that in the MVC group. Conclusion Valve calcification increases the risk of all-cause and cardiovascular mortality in MHD patients, also new-onset cardiovascular events, and aortic valve calcification contributes more to the risk of cardiovascular mortality.Keywords
Funding Information
- National Natural Science Foundation of China (81470954, 84170955)
- Medical Scientific Research Foundation of Guangdong Province of China (A2017325)
This publication has 33 references indexed in Scilit:
- Association of Cardiac Valvular Calcifications and C-Reactive Protein With Cardiovascular Mortality in Incident Hemodialysis Patients: A Japanese Cohort StudyAmerican Journal of Kidney Diseases, 2013
- Association Between Aortic Valve Calcification and Myocardial Ischemia, Especially in Asymptomatic PatientsJournal of Nuclear Medicine, 2012
- All-cause Mortality in Hemodialysis Patients with Heart Valve CalcificationClinical Journal of the American Society of Nephrology, 2011
- Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis populationNephrology Dialysis Transplantation, 2010
- Is Valvular Calcification a Part of the Missing Link between Residual Kidney Function and Cardiac Hypertrophy in Peritoneal Dialysis Patients?Clinical Journal of the American Society of Nephrology, 2009
- ForewordKidney International, 2009
- Vascular CalcificationJournal of the American Society of Nephrology, 2009
- Vascular calcifications, vertebral fractures and mortality in haemodialysis patientsNephrology Dialysis Transplantation, 2008
- ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)Journal of Invasive Cardiology, 2006
- Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findingsThe American Journal of Cardiology, 1986