Long-term haemodialysis was associated with structural valve changes in 64% of patients, with aortic stenosis significantly related to longer dialysis duration (101 vs 46 months, p=0.01).
Observational (n=62)
No
Patients on long-term haemodialysis have a high frequency of structural and functional abnormalities in the aortic and mitral valves, which may be related to dialysis duration and altered calcium metabolism.
OBJECTIVE: To identify valvar heart disease in patients with chronic uraemia by conventional and colour coded Doppler echocardiography. DESIGN: Case series of an unselected group of 62 patients with end stage renal failure. SETTING: Centre for haemodialysis in a referral hospital in Switzerland. PATIENTS: 62 patients on chronic haemodialysis. MAIN OUTCOME MEASURES: Frequency of structural and functional valve abnormalities and their relation to clinical findings. RESULTS: Structural changes were seen in 40 (64%) of 62 patients after 50 months (range 3-178 months) on haemodialysis. The mitral annulus and aortic cusps were thickened in 25 (40%) and in 34 (55%) patients respectively. Aortic stenosis was present in eight (mean (SD) age 60.5 (8.5) years), with a maximal instantaneous pressure gradient of 41 (14) mm Hg. Aortic regurgitation was seen in eight, mitral regurgitation in seven, and mitral stenosis in three patients. Patients with aortic stenosis had been on haemodialysis for significantly longer than the remaining patients (101 (43) v 46 (43) months, p = 0.01) and had significantly higher concentrations of serum alkaline phosphatase (176 (89) v 117 (47) IU/l, p less than 0.01) and of parathyroid hormone (54 (66) v 19 (29) ng/ml, p less than 0.02). CONCLUSIONS: Patients on long-term haemodialysis had an increased frequency of haemodynamically relevant changes in the aortic and mitral valves. The degenerative valve disease may be related in part to the duration of haemodialysis and to alterations in calcium metabolism as indicated by increased plasma concentrations of alkaline phosphatase and parathyroid hormone.
Straumann et al. (Sun,) conducted a observational in End stage renal failure on chronic haemodialysis (n=62). Long-term haemodialysis was evaluated on Frequency of structural and functional valve abnormalities. Long-term haemodialysis was associated with structural valve changes in 64% of patients, with aortic stenosis significantly related to longer dialysis duration (101 vs 46 months, p=0.01).