Prevalence and correlates of mitral annular calcification in adults with chronic kidney disease: Results from CRIC study

Abstract

Background Risk factors for mitral annular calcification (MAC) and cardiovascular disease (CVD) demonstrate significant overlap in the general population. The aim of this paper is to determine whether there are independent relationships between MAC and demographics, traditional and novel CVD risk factors using cardiac CT in the Chronic Renal Insufficiency Cohort (CRIC) in a cross-sectional study. Methods A sample of 2070 subjects underwent coronary calcium scanning during the CRIC study. Data were obtained for each participant at time of scan. Subjects were dichotomized into the presence and absence of MAC. Differences in baseline demographic and transitional risk factor data were evaluated across groups. Covariates used in multivariable adjustment were age, gender, BMI, HDL, LDL, lipid lowering medications, smoking status, family history of heart attack, hypertension, diabetes mellitus, phosphate, PTH, albuminuria, and calcium. Results Our study consisted of 2070 subjects, of which 331 had MAC (prevalence of 16.0%). The mean MAC score was 511.98 (SD 1368.76). Age and white race remained independently associated with presence of MAC. Decreased GFR was also a risk factor. African American and Hispanic race, as well as former smoking status were protective against MAC. In multivariable adjusted analyses, the remaining covariates were not significantly associated with MAC. Among renal covariates, elevated phosphate was significant. Conclusion In the CRIC population, presence of MAC was independently associated with age, Caucasian race, decreased GFR, and elevated phosphate. These results are suggested by mechanisms of dysregulation of inflammation, hormones, and electrolytes in subjects with renal disease.

Prevalence and Prognostic Implications of Mitral and Aortic Valve Calcium in Patients With Chronic Kidney Disease

“…4 Age, Caucasian race, decreased eGFR and elevated phosphate were independently associated with the presence of mitral annular calcification. 4 Elevated phosphate stimulates secondary hyperparathyroidism and is associated with increased circulating calcium and increased risk of valvular calcium. 4,18 In 92 long-term hemodialysis patients, hypertension, age, and calcium phosphate product were associated with mitral and/or aortic valve calcium.…”

“…Several risk factors for valvular calcium have been proposed in patients with CKD. 4,18 Among 2,070 patients with stage 2 and 3 CKD, 16% had mitral annular calcification. 4 Age, Caucasian race, decreased eGFR and elevated phosphate were independently associated with the presence of mitral annular calcification.…”

“…4,18 Among 2,070 patients with stage 2 and 3 CKD, 16% had mitral annular calcification. 4 Age, Caucasian race, decreased eGFR and elevated phosphate were independently associated with the presence of mitral annular calcification. 4 Elevated phosphate stimulates secondary hyperparathyroidism and is associated with increased circulating calcium and increased risk of valvular calcium.…”

“…3 Hypertension, inflammation, and dysregulated metabolic pathways, such as disorders in the calcium-phosphate metabolism, lead to the development of valvular calcium in patients with CKD. 4,5 Valvular calcium is associated with an increased risk of all-cause mortality in patients with end-stage renal disease. 6,7 However, the prognostic implications of left-sided valve calcium in patients with stage 2 and 3 CKD (estimated glomerular filtration rate [eGFR] of 60 to 89 ml/min/1.73 m 2 and 30 to 59 ml/min/1.73 m 2 respectively) are unknown.…”

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

“…Mitral annular calcification. Similar to aortic stenosis and aortic calcification, mitral annular calcification (MAC) shares biological links with atherosclerosis and is very common in patients with CKD 45,46 and aortic stenosis. MAC is particularly prevalent and extensive in patients undergoing HD.…”