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Valvular heart disease in patients with chronic kidney disease

Herzklappenerkrankungen bei Patienten mit chronischer Niereninsuffizienz

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Abstract

Valvular heart disease (VHD) is common in patients with impaired renal function, especially in those with end-stage renal disease (ESRD) undergoing dialysis. Progressive sclerosis and calcification of the valves and valvular annuli are major components of the etiology. These processes typically affect the aortic and mitral valve and can lead to both valvular insufficiency and stenosis. As recommended by the 2017 ESC/EACTS Guidelines for the management of VHD, surgical treatment remains the standard care for most cases of severe VHD. However, chronic kidney disease (CKD) is associated with increased mortality when compared with patients with preserved renal function. Interventional treatment options have emerged as an effective and safe alternative for patients older than 75 years and/or with increased surgical risk. Consequently, in patients with CKD at increased surgical risk who have suitable anatomical morphology, transcatheter replacement and/or repair should be discussed in the interdisciplinary “heart team.”

Zusammenfassung

Herzklappenerkrankungen sind eine häufige Komorbidität bei Patienten mit chronischer Niereninsuffizienz – insbesondere im Endstadium der Erkrankung mit der Notwendigkeit von Nierenersatzverfahren. Die fortschreitende Sklerose und Kalzifizierung der Herzklappen sowie des Klappenrings sind wesentlicher Bestandteil der Ätiologie. Diese Prozesse betreffen insbesondere die Aorten- und Mitralklappe und können sowohl zu einer Insuffizienz als auch zu einer Stenose der betroffenen Herzklappe führen. In der aktuellen Leitlinie zum Management von Herzklappenerkrankungen der Europäischen Gesellschaften für Kardiologie und Kardiochirurgie von 2017 (ESC, European Society of Cardiology; EACTS, European Association for Cardio-Thoracic Surgery) stellt der operative Klappenersatz das Standardverfahren für die meisten behandlungsbedürftigen Klappenvitien dar. Allerdings besteht bei Patienten mit chronischer Niereninsuffizienz ein erhöhtes Mortalitätsrisiko im Vergleich zu Patienten ohne Niereninsuffizienz. Katheterbasierte Klappenersatzverfahren haben sich in den letzten Jahren als sichere und effektive Behandlungsalternative bei Patienten >75 Jahren und/oder einem erhöhten Operationsrisiko etabliert. Daher sollten bei Patienten mit chronischer Niereninsuffizienz, welche ein erhöhtes Operationsrisiko aufweisen, bei geeigneter Anatomie kathetergestützte Therapieverfahren wie Klappenersatz oder Klappenrekonstruktion im interdisziplinären „Herzteam“ diskutiert werden.

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References

  1. Go AS, Chertow GM, Fan D et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305. https://doi.org/10.1056/NEJMoa041031

    Article  CAS  PubMed  Google Scholar 

  2. Samad Z, Sivak JA, Phelan M et al (2017) Prevalence and outcomes of left-sided valvular heart disease associated with chronic kidney disease. J Am Heart Assoc 6(10):e6044. https://doi.org/10.1161/JAHA.117.006044

    Article  PubMed  PubMed Central  Google Scholar 

  3. Abd Alamir M, Radulescu V, Goyfman M et al (2015) Prevalence and correlates of mitral annular calcification in adults with chronic kidney disease: results from CRIC study. Atherosclerosis 242(1):117–122. https://doi.org/10.1016/j.atherosclerosis.2015.07.013

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ribeiro S, Ramos A, Brandao A et al (1998) Cardiac valve calcification in haemodialysis patients: role of calcium-phosphate metabolism. Nephrol Dial Transplant 13(8):2037–2040. https://doi.org/10.1093/ndt/13.8.2037

    Article  CAS  PubMed  Google Scholar 

  5. Rong S, Qiu X, Jin X et al (2018) Risk factors for heart valve calcification in chronic kidney disease. Medicine (Baltimore) 97(5):e9804. https://doi.org/10.1097/MD.0000000000009804

    Article  Google Scholar 

  6. Urena-Torres P, D’Marco L, Raggi P et al (2019) Valvular heart disease and calcification in CKD: more common than appreciated. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfz133

    Article  PubMed  PubMed Central  Google Scholar 

  7. Baumgartner H, Falk V, Bax JJ et al (2017) 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791. https://doi.org/10.1093/eurheartj/ehx391

    Article  PubMed  Google Scholar 

  8. Nasri H, Baradaran A, Naderi AS (2004) Close association between parathyroid hormone and left ventricular function and structure in end-stage renal failure patients under maintenance hemodialysis. Acta Med Austriaca 31(3):67–72

    PubMed  Google Scholar 

  9. Patel KK, Shah SY, Arrigain S et al (2019) Characteristics and outcomes of patients with aortic stenosis and chronic kidney disease. JAHA 8(3):e9980. https://doi.org/10.1161/JAHA.118.009980

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wang Z, Jiang A, Wei F, Chen H (2018) Cardiac valve calcification and risk of cardiovascular or all-cause mortality in dialysis patients: a meta-analysis. BMC Cardiovasc Disord 18(1):12. https://doi.org/10.1186/s12872-018-0747-y

    Article  PubMed  PubMed Central  Google Scholar 

  11. Moshar S, Bayesh S, Mohsenikia M, Najibpour R (2016) The association of calcium-phosphorus product with the severity of cardiac valves failure in patients under chronic hemodialysis. Cardiol Res 7(2):80–83. https://doi.org/10.14740/cr465w

    Article  PubMed  PubMed Central  Google Scholar 

  12. Straumann E, Meyer B, Misteli M et al (1992) Aortic and mitral valve disease in patients with end stage renal failure on long-term haemodialysis. Br Heart J 67(3):236–239. https://doi.org/10.1136/hrt.67.3.236

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. K/DOQI Workgroup (2005) K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45(4):S1–153

    Article  Google Scholar 

  14. Habib G, Lancellotti P, Antunes MJ et al (2015) 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European society of cardiology (ESC). Endorsed by: European association for cardio-thoracic surgery (EACTS), the European association of nuclear medicine (EANM). Eur Heart J 36(44):3075–3128. https://doi.org/10.1093/eurheartj/ehv319

    Article  PubMed  Google Scholar 

  15. Fernando M, Paterson HS, Byth K et al (2014) Outcomes of cardiac surgery in chronic kidney disease. J Thorac Cardiovasc Surg 148(5):2167–2173. https://doi.org/10.1016/j.jtcvs.2013.12.064

    Article  PubMed  Google Scholar 

  16. Herzog CA, Ma JZ, Collins AJ (2002) Long-term survival of dialysis patients in the United States with prosthetic heart valves: should ACC/AHA practice guidelines on valve selection be modified? Circulation 105(11):1336–1341. https://doi.org/10.1161/hc1102.100075

    Article  PubMed  Google Scholar 

  17. Siontis GCM, Overtchouk P, Cahill TJ et al (2019) Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J 40(38):3143–3153. https://doi.org/10.1093/eurheartj/ehz275

    Article  PubMed  Google Scholar 

  18. Mack MJ, Leon MB, Thourani VH et al (2019) Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 380(18):1695–1705. https://doi.org/10.1056/NEJMoa1814052

    Article  PubMed  Google Scholar 

  19. Popma JJ, Deeb GM, Yakubov SJ et al (2019) Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med 380(18):1706–1715. https://doi.org/10.1056/NEJMoa1816885

    Article  PubMed  Google Scholar 

  20. Makki N, Lilly SM (2018) Advanced chronic kidney disease: relationship to outcomes post-TAVR, a meta-analysis. Clin Cardiol 41(8):1091–1096. https://doi.org/10.1002/clc.22993

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cubeddu RJ, Asher CR, Lowry AM et al (2020) Impact of transcatheter aortic valve replacement on severity of chronic kidney disease. J Am Coll Cardiol 76(12):1410–1421. https://doi.org/10.1016/j.jacc.2020.07.048

    Article  PubMed  Google Scholar 

  22. Shah K, Chaker Z, Busu T et al (2019) meta-analysis comparing renal outcomes after transcatheter versus surgical aortic valve replacement. J Interv Cardiol 2019:3537256. https://doi.org/10.1155/2019/3537256

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mihaljevic T, Lam BK, Rajeswaran J et al (2007) Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol 49(22):2191–2201. https://doi.org/10.1016/j.jacc.2007.02.043

    Article  PubMed  Google Scholar 

  24. Marmagkiolis K, Hakeem A, Ebersole DG et al (2019) Clinical outcomes of percutaneous mitral valve repair with MitraClip for the management of functional mitral regurgitation. Catheter Cardiovasc Interv 94(6):820–826. https://doi.org/10.1002/ccd.28203

    Article  PubMed  Google Scholar 

  25. Boekstegers P, Hausleiter J, Baldus S et al (2014) Percutaneous interventional mitral regurgitation treatment using the Mitra-Clip system. Clin Res Cardiol 103(2):85–96. https://doi.org/10.1007/s00392-013-0614-x

    Article  CAS  PubMed  Google Scholar 

  26. Stone GW, Lindenfeld J, Abraham WT et al (2018) Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med 379(24):2307–2318. https://doi.org/10.1056/NEJMoa1806640

    Article  PubMed  Google Scholar 

  27. Hagendorff A, Doenst T, Falk V (2019) Echocardiographic assessment of functional mitral regurgitation: opening Pandora’s box? ESC Heart Fail 6(4):678–685. https://doi.org/10.1002/ehf2.12491

    Article  PubMed  PubMed Central  Google Scholar 

  28. Shah B, Villablanca PA, Vemulapalli S et al (2019) Outcomes after transcatheter mitral valve repair in patients with renal disease. Circ Cardiovasc Interv 12(2):e7552. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007552

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wang A, Sangli C, Lim S et al (2015) Evaluation of renal function before and after percutaneous mitral valve repair. Circ Cardiovasc Interv 8(1):e1349. https://doi.org/10.1161/CIRCINTERVENTIONS.113.001349

    Article  PubMed  Google Scholar 

  30. Sawalha K, Al-Akchar M, Ibrahim A et al (2020) Impact of chronic kidney disease on in-hospital outcomes and readmission rate after edge-to-edge transcatheter mitral valve repair. Catheter Cardiovasc Interv. https://doi.org/10.1002/ccd.29188

    Article  PubMed  Google Scholar 

  31. Doshi R, Shlofmitz E, Shah J, Meraj P (2018) Comparison of transcatheter mitral valve repair versus surgical mitral valve repair in patients with advanced kidney disease (from the national inpatient sample). Am J Cardiol 121(6):762–767. https://doi.org/10.1016/j.amjcard.2017.12.015

    Article  PubMed  Google Scholar 

  32. Taramasso M, Pozzoli A, Guidotti A et al (2017) Percutaneous tricuspid valve therapies: the new frontier. Eur Heart J 38(9):639–647. https://doi.org/10.1093/eurheartj/ehv766

    Article  PubMed  Google Scholar 

  33. Nickenig G, Weber M, Lurz P et al (2019) Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6‑month outcomes of the TRILUMINATE single-arm study. Lancet 394(10213):2002–2011. https://doi.org/10.1016/S0140-6736(19)32600-5

    Article  PubMed  Google Scholar 

  34. Nickenig G, Kowalski M, Hausleiter J et al (2017) Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge Mitraclip technique. Circulation 135(19):1802–1814. https://doi.org/10.1161/CIRCULATIONAHA.116.024848

    Article  PubMed  Google Scholar 

  35. Karam N, Braun D, Mehr M et al (2019) Impact of transcatheter tricuspid valve repair for severe tricuspid regurgitation on kidney and liver function. JACC Cardiovasc Interv 12(15):1413–1420. https://doi.org/10.1016/j.jcin.2019.04.018

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was supported by the SFB/TRR219 Consortium “Mechanisms of Cardiovascular Complications in Chronic Kidney Disease” funded by the German Research Foundation. The images in Fig. 2 are used with permission from Servier (http://smart.servier.com/). Servier Medical Art by Servier is licensed under a Creative Commons Attribution 3.0 unported License.

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  1. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Hospital, Kirrberger Str., IMED, 66421, Homburg/Saar, Germany

    Julian Hoevelmann, Felix Mahfoud, Lucas Lauder, Bruno Scheller, Michael Böhm & Sebastian Ewen

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Correspondence to Julian Hoevelmann.

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F. Mahfoud is supported by the Deutsche Gesellschaft für Kardiologie (DGK) and Deutsche Forschungsgemeinschaft (SFB TRR219) and has received scientific support and speaker honoraria from Bayer, Boehringer Ingelheim, Medtronic, and ReCor Medical. M. Böhm is supported by the Deutsche Forschungsgemeinschaft (SFB TRR218). S. Ewen received speakers or consultant honorarium and/or travel support from Medtronic, Recor, Bayer, Daiichi Sankyo, Boehringer Ingelheim, Novartis, AstraZeneca, Akcea Therapeutics, and Bristol-Myers Squibb-Pfizer. J. Hoevelmann, L. Lauder and B. Scheller declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Hoevelmann, J., Mahfoud, F., Lauder, L. et al. Valvular heart disease in patients with chronic kidney disease. Herz 46, 228–233 (2021). https://doi.org/10.1007/s00059-020-05011-0

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