Calcific Aortic Stenosis: A Complication of Chronic Uraemia

Abstract

The incidence of aortic stenosis was studied in 174 consecutive patients aged < 55 years at initiation of maintenance haemodialysis. Severe, calcific aortic stenosis developed in 6 patients a mean 9.7 years after starting haemodialysis (p = 0.0004 compared to population incidence). In 5 patients stenosis was due to severe premature calcification of a tricuspid aortic valve. Necropsy proven aortic valve calcification (with or without stenosis) was associated with an increased duration of haemodialysis, age > 35 years at starting dialysis and mitral annular calcification. There is an increased incidence of aortic stenosis in patients with chronic renal failure due to premature valvular calcification, which may be related to abnormal calcium and phosphate metabolism in uraemia.

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

“…Degenerative valvular calcification is more prevalent and progresses faster in ESRD than in the general population, likely because of abnormal calcium and phosphate metabolism, secondary hyperparathyroidism, and vitamin D and calcium supplementation 99, 100, 101. These metabolic abnormalities lead to increased calcium deposition in the mitral annulus and aortic valve.…”

“…These metabolic abnormalities lead to increased calcium deposition in the mitral annulus and aortic valve. Consequently, the incidence of aortic valve calcification (AVC) is nearly twice that in the general population and has a direct relationship with time spent on dialysis 99, 100, 101. In patients on dialysis, AVC is often severe and can lead to rapidly progressing aortic stenosis (AS)20.…”

“…Similar to accelerated AVC, 36% of patients had mitral annular calcification that was associated with age, age at initiation of dialysis, calcium phosphate product, and time spent on dialysis 101. Progressive mitral annular calcification can cause functional impairment by encroachment to the mitral leaflets, leading to mitral regurgitation and/or mitral stenosis.…”

“…Current guidelines recommend AVR in patients with asymptomatic severe AS and an LVEF <50% who have a decreased systolic opening of a calcified aortic valve with an aortic valve velocity ≥4.0 m/s or mean pressure gradient ≥40 mm Hg 103. Nevertheless, patients with advanced CKD and ESRD represent a population that is at high risk for rapid progression of AS 20, 99, 100, 101. LVH, reduced LVEF, and PH are all linked to a higher risk of adverse events in patients with AS and are highly prevalent in patients with advanced CKD and ESRD 113, 114, 115, 116.…”

Pathogenesis of Calcific Aortic Valve Disease

“…39 However, a more recent study found no correlation between LDL or total cholesterol levels and risk of aortic stenosis progression. 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.…”