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Valvular heart disease and calcification in CKD: more common than appreciated
Pablo Ureña-Torres1,2, Luis D'Marco3,4, Paolo Raggi5
1Department of Dialysis, AURA Nord Saint Ouen, Saint Ouen, France.
Insights
Valvular calcification (VC) significantly increases mortality risk in chronic kidney disease (CKD) patients, occurring earlier than in the general population. This review highlights VC
Area of Science:
- Nephrology
- Cardiology
- Pathophysiology
Background:
- Cardiovascular diseases are leading causes of death in advanced chronic kidney disease (CKD).
- Vascular and valvular calcification (VC) are implicated in CKD complications, but VC's impact on survival is understudied.
- VC in CKD patients occurs 10-20 years earlier than in the general population.
Purpose of the Study:
- To review the pathophysiology and clinical relevance of valvular calcification in CKD patients.
- To highlight the specific clinical consequences of VC in this population.
- To discuss potential therapeutic strategies for managing VC in CKD.
Main Methods:
- Literature review focusing on valvular calcification in chronic kidney disease.
- Synthesis of current knowledge on VC pathophysiology and clinical impact.
- Analysis of studies investigating VC prevalence, incidence, and outcomes in CKD.
Main Results:
- Valvular calcification is prevalent in CKD patients, with annual incidence of aortic valve calcification at 3.3% in dialysis patients.
- Aortic and mitral VC prevalence ranges from 25% to 59% in CKD.
- VC is associated with increased mortality and distinct clinical consequences compared to vascular calcification.
Conclusions:
- Valvular calcification poses a significant, underappreciated threat to CKD patient survival.
- VC in CKD is an accelerated process with unique clinical implications.
- Further research and targeted therapies are needed to address VC in chronic kidney disease.
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.
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