Left-sided valvular heart disease in dialysis recipients: a single-centre observational study

With the increasing prevalence of chronic kidney disease, the number of people receiving renal replacement is expected to increase by 50% by 2030. Cardiovascular mortality remains significantly higher in this population. The presence of valvular heart disease (VHD) in patients with end-stage renal disease is associated with poor survival. In a dialysis cohort, we assessed the prevalence and characteristics of patients with significant VHD, the association with clinical parameters and the impact on survival.

Echocardiographic parameters for dialysis recipients from a single centre in the UK were collected. Significant left-sided heart disease (LSHD) was defined as moderate or severe left valvular lesions or left ventricular systolic dysfunction (LVSD) (ejection fraction <45%) or both. Baseline demographic and clinical characteristics were ascertained.

In 521 dialysis recipients {median age 61 years [interquartile range (IQR) 50-72], 59% male}, 88% were on haemodialysis and the median dialysis vintage was 2.8 years (IQR 1.6-4.6). A total of 238 (46%) had evidence of LSHD: 102 had VHD, 63 had LVSD and 73 had both. Overall, 34% had evidence of left-sided VHD. In multivariable regression analysis, age and use of cinacalcet were associated with higher odds of VHD {odds ratio [OR] 1.03 [95% confidence interval (CI) 1.02-1.05] and OR 1.85 [95% CI 1.06-3.23], respectively}, while the use of phosphate binders was associated with increased odds of aortic stenosis [AS; OR 2.64 (95% CI 1.26-5.79)]. The 1-year survival was lower in VHD [78% versus 86% (95% CI 0.72-0.84 and 0.83-0.90), respectively] and in LSHD [78% versus 88% (95% CI 0.73-0.83 and 0.85-0.92), respectively]. In AS, the 1-year survival was 64% (95% CI 0.49-0.82). Using propensity score matching to adjust for age, diabetes and low serum albumin, AS was significantly associated with lower survival (P = .01). LSHD was significantly associated with worse survival (P = .008) compared with survival in LVSD (P = .054).

A high proportion of dialysis patients have clinically significant LSHD. This was associated with higher mortality. In valvular heart disease, the development of AS is independently associated with higher mortality in dialysis patients.