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The influence of cardiac valvular calcification on all-cause and cardiovascular mortality in maintenance hemodialysis patients

  • Nephrology - Original Paper
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Abstract

Objective

To investigate the effect of cardiac valve calcification (CVC) on all-cause and cardiovascular mortality in maintenance hemodialysis (MHD) patients.

Methods

A retrospective cohort study was conducted in 183 long-term hemodialysis patients with complete follow-up data from January 1, 2012, to December 30, 2015. The baseline data between CVC and non-CVC groups were compared. Kaplan–Meier method was used to analyze all-cause and cardiovascular mortality. The effect of CVC on prognosis was analyzed using the Cox proportional hazard regression model and subgroup analysis.

Results

Among 183 patients under hemodialysis, 104 (56.8%) were males, with an average age of 56.1 ± 17.0 years and 68 (37.2%) were complicated with valvular calcification. The median follow-up period was 30.8 months. All-cause and cardiovascular mortality were 50% vs. 14.8% and 25% vs. 7.0% in the CVC and non-CVC groups, respectively (P < 0.05). Kaplan–Meier indicated that differences in all-cause and cardiovascular mortality were statistically significant between the two groups (P < 0.001). Cox regression analysis showed that CVC significantly increased all-cause (hazards ratio [HR] 2.161 [1.083–4.315]) and cardiovascular mortality (3.435 [1.222–9.651]) after adjusting for multiple factors. Meanwhile, CVC also increases the incidence of new-onset cardiovascular events. Subgroup analysis revealed that all-cause and cardiovascular mortality were significantly higher in patients with aortic valve calcification (AVC) than in patients with mitral valve calcification (MVC). Multivariate calibration showed that AVC increased the risk of cardiovascular death (HR 5.486 [1.802–16.702]) (P < 0.05), whereas MVC did not. By further comparing the echocardiographic data of the two groups, the incidence of LVH and pulmonary hypertension in the AVC group was significantly higher than that in the MVC group.

Conclusion

Valve calcification increases the risk of all-cause and cardiovascular mortality in MHD patients, also new-onset cardiovascular events, and aortic valve calcification contributes more to the risk of cardiovascular mortality.

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Funding

This study was supported by the National Natural Science Foundation of China (Grant Nos. 81470954, 84170955) and the Medical Scientific Research Foundation of Guangdong Province of China (Grant No. A2017325).

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Author notes

  1. Ming Li and Zeng-chun Ye have contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600#, Guangzhou, 510630, People’s Republic of China

    Ming Li, Zeng-chun Ye, Can-ming Li, Wen-bo Zhao, Hua Tang, Xun Liu, Hui Peng & Tan-qi Lou

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  1. Ming Li
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Correspondence to Hui Peng or Tan-qi Lou.

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The study was approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University and participants gave their informed consent to participate.

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Li, M., Ye, Zc., Li, Cm. et al. The influence of cardiac valvular calcification on all-cause and cardiovascular mortality in maintenance hemodialysis patients. Int Urol Nephrol 52, 943–951 (2020). https://doi.org/10.1007/s11255-020-02448-4

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  • DOI: https://doi.org/10.1007/s11255-020-02448-4

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