Valvular heart disease in patients with chronic kidney disease

Area of Science:

• Cardiology
• Nephrology
• Cardiac Surgery

Background:

• Valvular heart disease (VHD) is common in patients with impaired renal function, particularly end-stage renal disease (ESRD) on dialysis.
• Progressive valvular sclerosis and calcification, affecting the aortic and mitral valves, lead to insufficiency and stenosis.
• Chronic kidney disease (CKD) significantly increases mortality risk in VHD patients compared to those with preserved renal function.

Purpose of the Study:

• To review the management of severe VHD in patients with CKD.
• To highlight the risks associated with surgical treatment in this population.
• To discuss the role of interventional cardiology in managing VHD in high-risk CKD patients.

Main Methods:

• Review of current guidelines (2017 ESC/EACTS) for VHD management.
• Analysis of outcomes for surgical versus interventional treatments in CKD patients.
• Emphasis on interdisciplinary "heart team" decision-making.

Main Results:

• Surgical treatment is standard for severe VHD but carries higher mortality in CKD patients.
• Interventional options, such as transcatheter valve replacement/repair, are effective and safe for elderly or high-risk patients.
• Transcatheter approaches should be considered for suitable CKD patients with increased surgical risk.

Conclusions:

• VHD management in CKD patients requires careful consideration of increased surgical risks.
• Transcatheter valve interventions represent a viable and safe alternative for select high-risk CKD patients.
• Interdisciplinary "heart team" discussion is crucial for optimal treatment planning in these complex cases.