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Calcific aortic stenosis: a complication of chronic uraemia
E R Maher1, M Pazianas, J R Curtis
1Department of Medicine, Charing Cross Hospital, London, UK.
Insights
Patients on chronic renal failure dialysis develop aortic stenosis due to premature calcification. This valvular calcification is linked to abnormal calcium and phosphate metabolism in uremia.
Area of Science:
- Nephrology
- Cardiology
- Pathology
Background:
- Chronic renal failure (CRF) patients undergoing maintenance hemodialysis are at risk for cardiovascular complications.
- Aortic stenosis (AS) is a significant valvular heart disease, but its incidence in younger CRF patients is not well-established.
Purpose of the Study:
- To investigate the incidence and characteristics of aortic stenosis in patients under 55 years old initiating maintenance hemodialysis.
- To identify factors associated with the development of aortic valve calcification and stenosis in this cohort.
Main Methods:
- A prospective study of 174 consecutive patients aged less than 55 years at the start of maintenance hemodialysis.
- Follow-up for the development of severe aortic stenosis, with necropsy data analyzed for valve calcification.
Main Results:
- Six patients (3.4%) developed severe, calcific aortic stenosis a mean of 9.7 years after starting hemodialysis (p = 0.0004 vs. population incidence).
- In 5 of these patients, stenosis resulted from premature calcification of a tricuspid aortic valve.
- Aortic valve calcification was associated with longer dialysis duration, age >35 years at dialysis initiation, and mitral annular calcification.
Conclusions:
- There is an increased incidence of aortic stenosis in patients with chronic renal failure, characterized by premature valvular calcification.
- Abnormal calcium and phosphate metabolism in uremia may contribute to the accelerated valvular calcification observed in these patients.
Abstract:
The incidence of aortic stenosis was studied in 174 consecutive patients aged less than 55 years at initiation of maintenance haemodialysis. Severe, calcific aortic stenosis developed in 6 patients a mean 9.7 years after starting haemodialysis (p = 0.0004 compared to population incidence). In 5 patients stenosis was due to severe premature calcification of a tricuspid aortic valve. Necropsy proven aortic valve calcification (with or without stenosis) was associated with an increased duration of haemodialysis, age greater than 35 years at starting dialysis and mitral annular calcification. There is an increased incidence of aortic stenosis in patients with chronic renal failure due to premature valvular calcification, which may be related to abnormal calcium and phosphate metabolism in uraemia.