Skip to main content
SpringerLink
Log in

Cardiac valve calcification as a predictor of cardiovascular outcomes in peritoneal dialysis patients: an inverse probability of treatment weighting analysis

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

Cardiovascular events (CVE) are the leading cause of death in peritoneal dialysis (PD) patients. The predictive value of cardiac valve calcification (CVC) for CVE in dialysis patients remains controversial. In particular, such studies are limited in PD patients. We aimed to examine the predictive role of CVC for CVE and cardiovascular mortality in PD patients.

Methods

A retrospective analysis was performed on patients who initiated PD in our hospital. According to the result of echocardiography, patients were divided into CVC group and non-CVC group. The differences in baseline demographic characteristics, biochemical variables, comorbidities, and clinical outcomes between the two groups were compared. Kaplan–Meier method was used to obtain survival curves. The Cox regression model was used to evaluate the influence of CVC for cardiovascular outcomes. The inverse probability of treatment weighting (IPTW) was used to eliminate influence of the confounders in the groups.

Results

458 peritoneal dialysis patients were enrolled in this study. 77 patients were in CVC group and 381 patients in non-CVC group. The average follow-up time was (32 ± 21) months. At baseline, the absolute standardized difference (ASD) of age, BMI, history of CVE, diabetes, LVEF, LVMI, albumin, calcium, phosphorus, triglycerides, hsCRP, urine volume, Kt/V, statins and vitamin D intake rate were greater than 0.1 between the two groups. All of ASD dropped to less than 0.1 after IPTW, which meant that the balance had been reached between the two groups. Multivariable logistic analysis showed that advanced age, diabetes, and hyperphosphatemia were associated with CVC. The Kaplan–Meier survival curve showed the cumulative CVE-free survival rate and cardiovascular survival rate of CVC group were significantly lower than that of non-CVC group before and after IPTW (log-rank P < 0.05). After IPTW was used to eliminate the effect of confounders, multivariate Cox regression analysis still showed CVC was an independent risk factor for CVE (HR = 2.383, 95% CI 1.331~4.264, P = 0.003) and cardiovascular mortality (HR = 2.347, 95% CI 1.211~4.548, P = 0.012) in PD patients.

Conclusion

The prevalence of CVC is high in peritoneal dialysis patients. CVC is an independent risk factor for CVE and cardiovascular mortality in peritoneal dialysis patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Liu X, Hu Z, Xu X et al (2020) The associations of plant-based protein intake with all-cause and cardiovascular mortality in patients on peritoneal dialysis. Nutr Metab Cardiovasc Dis 30:967–976

    Article  CAS  PubMed  Google Scholar 

  2. Modi ZJ, Lu Y, Ji N et al (2019) Risk of cardiovascular disease and mortality in young adults with end-stage renal disease. Jama Cardiol 4:353

    Article  PubMed  PubMed Central  Google Scholar 

  3. Liu ZH, Yu XQ, Yang JW et al (2018) Prevalence and risk factors for vascular calcification in Chinese patients receiving dialysis: baseline results from a prospective cohort study. Curr Med Res Opin 34:1491–1500

    Article  PubMed  Google Scholar 

  4. Li M, Ye Z, Li C et al (2020) The influence of cardiac valvular calcification on all-cause and cardiovascular mortality in maintenance hemodialysis patients. Int Urol Nephrol 52:943–951

    Article  CAS  PubMed  Google Scholar 

  5. Li ZL, He CS, Chen YH et al (2016) Association of heart valve calcification with cardiovascular outcomes in patients on maintenance hemodialysis. Nan Fang Yi Ke Da Xue Xue Bao 36:941–946

    CAS  PubMed  Google Scholar 

  6. Panuccio V, Tripepi R, Tripepi G et al (2004) Heart valve calcifications, survival, and cardiovascular risk in hemodialysis patients. Am J Kidney Dis 43:479–484

    Article  PubMed  Google Scholar 

  7. Shen A, Jiang L, Tian Y et al (2021) Valvular calcific deposits and mortality in peritoneal dialysis patients: a propensity score-matched cohort analysis. Cardiorenal Med 11:200–207

    Article  PubMed  Google Scholar 

  8. Tian Y, Feng S, Zhan Z et al (2016) Risk factors for new-onset cardiac valve calcification in patients on maintenance peritoneal dialysis. Cardiorenal Med 6:150–158

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Rebic D, Rasic S, Hamzic-Mehmedbasic A et al (2015) Valvular calcification and left ventricular modifying in peritoneal dialysis patients. Ren Fail 37:1316–1322

    Article  PubMed  Google Scholar 

  10. Austin PC (2016) Variance estimation when using inverse probability of treatment weighting (IPTW) with survival analysis. Stat Med 35:5642–5655

    Article  PubMed  PubMed Central  Google Scholar 

  11. Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chen SC, Huang JC, Tsai YC et al (2016) Body mass index, left ventricular mass index and cardiovascular events in chronic kidney disease. Am J Med Sci 351:91–96

    Article  PubMed  Google Scholar 

  13. KDIGO (2017) Clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 7:1–59

    Article  Google Scholar 

  14. Wang Z, Jiang A, Wei F et al (2018) Cardiac valve calcification and risk of cardiovascular or all-cause mortality in dialysis patients: a meta-analysis. Bmc Cardiovasc Disor 18:12

    Article  Google Scholar 

  15. Ávila-Díaz M, Mora-Villalpando C, Prado-Uribe MDC et al (2013) De novo development of heart valve calcification in incident peritoneal dialysis patients. Arch Med Res 44:638–644

    Article  PubMed  Google Scholar 

  16. Chen NX, Duan D, O’Neill KD et al (2006) High glucose increases the expression of Cbfa1 and BMP-2 and enhances the calcification of vascular smooth muscle cells. Nephrol Dial Transpl 21:3435–3442

    Article  CAS  Google Scholar 

  17. Boström KI, Jumabay M, Matveyenko A et al (2011) Activation of vascular bone morphogenetic protein signaling in diabetes mellitus. Circ Res 108:446–457

    Article  PubMed  Google Scholar 

  18. Hénaut L, Chillon J, Kamel S et al (2018) Updates on the mechanisms and the care of cardiovascular calcification in chronic kidney disease. Semin Nephrol 38:233–250

    Article  PubMed  Google Scholar 

  19. Bäck M, Michel J (2021) From organic and inorganic phosphates to valvular and vascular calcifications. Cardiovasc Res 117:2016–2029

    Article  PubMed  PubMed Central  Google Scholar 

  20. Plytzanopoulou P, Papasotiriou M, Politis P et al (2020) Malnutrition as a risk factor for cardiac valve calcification in patients under maintenance dialysis: a cross-sectional study. Int Urol Nephrol 52:2205–2212

    Article  CAS  PubMed  Google Scholar 

  21. Yee M, Wang A, Woo J, Wang M et al (2001) Association of inflammation and malnutrition with cardiac valve calcification in continuous ambulatory peritoneal dialysis patients. J Am Soc Nephrol 12:1927–1936

    Article  Google Scholar 

  22. Chen XN, Chen ZJ, Ma XB et al (2015) Aortic artery and cardiac valve calcification are associated with mortality in Chinese hemodialysis patients: a 3.5 years follow-up. Chin Med J (Engl) 128:2764–2771

    Article  CAS  PubMed  Google Scholar 

  23. Austin PC (2013) The performance of different propensity score methods for estimating marginal hazard ratios. Stat Med 32:2837–2849

    Article  PubMed  Google Scholar 

  24. Dai L, Plunde O, Qureshi AR et al (2020) Aortic valve calcium associates with all-cause mortality independent of coronary artery calcium and inflammation in patients with end-stage renal disease. J Clin Med 9:607

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ma D, Yan H, Yang X et al (2020) Abdominal aortic calcification score as a predictor of clinical outcome in peritoneal dialysis patients: a prospective cohort study. BMC Nephrol 21:151

    Article  PubMed  PubMed Central  Google Scholar 

  26. Xie Q, Ge X, Shang D et al (2016) Coronary artery calcification score as a predictor of all-cause mortality and cardiovascular outcome in peritoneal dialysis patients. Perit Dial Int 36:163–170

    Article  PubMed  PubMed Central  Google Scholar 

  27. Xiong J, Chen X, Liang C et al (2022) Prognosis and risk factors for cardiac valve calcification in Chinese end-stage kidney disease patients on combination therapy with hemodialysis and hemodiafiltration. Ren Fail 44:224–232

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Choi MJ, Kim JK, Kim SG et al (2013) Association between cardiac valvular calcification and myocardial ischemia in asymptomatic high-risk patients with end-stage renal disease. Atherosclerosis 229:369–373

    Article  CAS  PubMed  Google Scholar 

  29. O’Neal WT, Efird JT, Nazarian S et al (2015) Mitral annular calcification and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis. Europace 17:358–363

    Article  PubMed  Google Scholar 

  30. Pekdemir H, Cansel M, Yagmur J et al (2010) Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in patients with mitral annulus calcification. J Electrocardiol 43:339–343

    Article  PubMed  Google Scholar 

  31. Fashanu OE, Bizanti A, Al-Abdouh A et al (2020) Progression of valvular calcification and risk of incident stroke: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 307:32–38

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Wang AY, Ho SS, Wang M et al (2005) Cardiac valvular calcification as a marker of atherosclerosis and arterial calcification in end-stage renal disease. Arch Intern Med 165:327

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by Health Science and Technology Program of Zhejiang Province of China (Grant No. 2022KY396).

Author information

Authors and Affiliations

  1. Department of Nephrology, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China

    Jichao Guan, Haiying Xie, Hongya Wang, Shuwen Gong, Xiujuan Wu, Tujian Gong & Shuijuan Shen

Authors
  1. Jichao Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haiying Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hongya Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shuwen Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiujuan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tujian Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shuijuan Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jichao Guan.

Ethics declarations

Conflict of interest

The authors report no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guan, J., Xie, H., Wang, H. et al. Cardiac valve calcification as a predictor of cardiovascular outcomes in peritoneal dialysis patients: an inverse probability of treatment weighting analysis. Int Urol Nephrol 55, 1271–1278 (2023). https://doi.org/10.1007/s11255-022-03430-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-022-03430-y

Keywords

Search

Navigation