Valvular heart disease and calcification in CKD: more common than appreciated

Abstract

Ischaemic heart disease, sudden cardiac death and arrhythmias, heart failure, stroke and peripheral arterial disease make up >50% of the causes of death in advanced chronic kidney disease (CKD). Calcification of the vascular tree and heart valves is partially related to these complications and has received growing attention in the literature. However, the main focus of research has been on the pathophysiology and consequences of vascular calcification, with less attention being paid to valvular calcification (VC) and its impact on the survival of CKD patients. Although VC has long been seen as an age-related degenerative disorder with minimal functional impact, several studies proved that it carries an increased risk of death and clinical consequences different from those of vascular calcification. In dialysis patients, the annual incidence of aortic valve calcification is nearly 3.3% and the reported prevalence of aortic and mitral VC varies between 25% and 59%. Moreover, calcification of both valves occurs 10–20 years earlier in CKD patients compared with the general population. Therefore, the purpose of this review is to summarize the current knowledge on the pathophysiology and relevance of VC in CKD patients, and to highlight specific clinical consequences and potential therapeutic implications.

Prognostic Significance of Abnormal Ankle–Brachial Index Among Long-term Hemodialysis Patients in Kinshasa, the Democratic Republic of the Congo

“… 27 , 28 In addition to multiple traditional and emerging cardiovascular risk factors, the association of abnormal ABI with arrhythmia in chronic hemodialysis patients in the present study could be explained by the presence of valvular calcifications as reported by Ureña-Torres. 29 Although vascular access failure has been reported to be frequently associated with abnormal ABI in chronic hemodialysis patients, 30 the lack of association observed in the present study, where most patients used either temporary or permanent catheters, could be due to the small study sample size.…”

Serum Alkaline Phosphatase Level Predicts Cardiac Valve Calcification in Maintenance Hemodialysis Patients

“…As recently revised by Urena-Torres et al [29], multiple mechanisms were involved in the pathogenesis of CVC, including genetic, mechanical, biochemical, and therapeutic factors. Several polymorphisms and products of genes such as lipoprote A gene and Notch gene play a role in the process of aortic valve calcification.…”

Cardiovascular Disease in Chronic Kidney Disease

“…Valvular disease in patients with CKD is accelerated by comorbidities like diabetes, arterial hypertension, hyperlipidemia, anemia and ongoing infections of valves, and malnutrition, as well as hypercalcemia, hyperphosphatemia, and hyperparathyroidism. 85 …”