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Evolutive aortic stenosis in hemodialysis patients: analysis of risk factors
P Ureña1, M C Malergue, B Goldfarb
1Service de néphrologie et dialyse, clinique de l'Orangerie, Aubervilliers.
Insights
Aortic stenosis (AS) is common and deadly in hemodialysis patients. Risk factors include older age, high vitamin D3, and hyperphosphatemia, often linked to hypoparathyroidism.
Area of Science:
- Nephrology
- Cardiology
- Valvular Heart Disease
Background:
- Cardiovascular diseases are the leading cause of death in hemodialysis patients.
- Uremia's impact on cardiac valves, particularly aortic stenosis (AS), is poorly understood.
Purpose of the Study:
- To investigate the incidence and progression of aortic stenosis in hemodialysis patients.
- To identify risk factors associated with AS development and poor outcomes in this population.
Main Methods:
- Retrospective study of 110 hemodialysis patients from 1991-1996.
- Doppler-echocardiography used to assess aortic valve area and diagnose AS.
- Kaplan-Meier survival analysis and logistic regression for risk factor identification.
Main Results:
- Progressive AS developed in 16 patients over 16.8 months, with an annual incidence of 3.3%.
- AS patients had significantly lower survival rates (p < 0.001) and a higher mortality rate within 3 years.
- Risk factors identified include older age, male sex, higher calcium-phosphorus product (due to hyperphosphatemia), and elevated plasma vitamin D3 levels.
Conclusions:
- Aortic stenosis is a frequent complication with a poor prognosis in hemodialysis patients.
- Age, hyperphosphatemia (often associated with hypoparathyroidism), and elevated vitamin D3 are significant risk factors for AS.
- Early identification and management of these risk factors are crucial for improving outcomes.
Abstract:
Cardiovascular diseases represent the major cause of death in hemodialysis patients. However, little information is available about the repercussion of uremia on cardiac valves. We retrospectively investigated the incidence rate of aortic stenosis (AS), from 1991 to 1996, in 110 hemodialysis patients followed by Doppler-echocardiography. Progressive AS was diagnosed in 16 patients who had a decrease in their indexed aortic valve area from 1.24 +/- 0.09 to 0.66 +/- 0.21 cm2/m2 of BSA in 16.8 +/- 1.9 months. The mean incidence of AS per year was of 3.3%, ranging from 1.5 to 8.0%. Eight patients died in less than 3 years after the diagnosis of AS with a mean survival time of 23.0 +/- 9.5 months. Survival curves using Kaplan-Meier estimates showed a statistically significant decrease in the survival rate of patients with AS compared with patients without valvulopathy (p < 0.001). They were older than patients with normal valve, 68.6 +/- 11.1 versus 56.7 +/- 16.0 years, respectively. Men were 4 times more affected than women and showed a significantly more rapid progression to AS than women. The calcium-phosphorus product was higher in AS patients, 5.43 +/- 0.98 than in patients without AS, 3.95 +/- 0.50 mM. It was mainly due to hyperphosphatemia without hypercalcemia and the hyperphosphatemia was associated with biological signs of hypoparathyroidism or adynamic bone disease in 62% of the cases. Plasma vitamin D3 was also higher in patients with AS, 20.5 +/- 13.5 ng/ml than in those with normal valves, 9.6 +/- 6.3 ng/ml. Logistic regression showed that age, vitamin D3 and hyperphosphatemia correctly predicted 56% of the AS cases. In conclusion, AS is frequent and of poor outcome in hemodialysis patients. Age, relatively high plasma vitamin D3 levels, and hyperphosphatemia, mostly due to hypoparathyroidism, must be considered as risk factors.