What question did this study set out to answer?

To determine the prognostic significance of mitral and aortic valve calcification on all-cause mortality in patients with end-stage kidney disease undergoing hemodialysis.

June 25, 2011Clinical Journal of the American Society of NephrologyOpen Access

All-cause Mortality in Hemodialysis Patients with Heart Valve Calcification

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hemodialysis (CKD-5D) (n=144). Intervention: Mitral valve calcification vs. No mitral valve calcification. Primary outcome: All-cause mortality (HR 1.73, 95% CI 1.03 to 2.91, p=0.04).

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Key result

Mitral valve calcification was independently associated with a significantly increased risk of all-cause mortality (HR 1.73) in hemodialysis patients.

Why the study?

Does valvular calcification predict all-cause mortality in adult hemodialysis patients?

Key Points

To determine the prognostic significance of mitral and aortic valve calcification on all-cause mortality in patients with end-stage kidney disease undergoing hemodialysis.
Assessed 144 adult hemodialysis (CKD-5D) patients using bidimensional echocardiography for qualitative valvular calcification and cardiac CT for quantitative valvular and coronary artery calcium.
Followed participants for a median duration of 5.6 years to evaluate all-cause mortality.
Mitral valve calcification was detected in 38.2% and aortic valve calcification in 44.4% of patients, with mitral calcification independently predicting mortality after multivariable adjustment (HR, 1.73; 95% CI, 1.03 to 2.91).
Patients with calcification in both heart valves experienced more than double the mortality risk compared with those without calcification (HR, 2.16; 95% CI, 1.14 to 4.08).
A combined CT score assessing valvular and coronary artery calcium strongly predicted all-cause mortality when comparing the highest to the lowest tertile (HR, 2.21; 95% CI, 1.08 to 4.54).

Study Design

Type

Cohort (n=144)

Multicenter

Yes

Structured PICO

Does valvular calcification predict all-cause mortality in adult hemodialysis patients?

Population

144 adult hemodialysis patients followed for a median of 5.6 years to evaluate the prognostic significance of cardiac valve calcification.

Exposure

Presence of valvular calcification (mitral and/or aortic) assessed by bidimensional echocardiography and cardiac computed tomography

Comparator

Absence of valvular calcification

Outcome

All-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.73 (95% CI 1.03–2.91)

Absolute Event Rate: 128.7% vs 67.9%

p-value: p=0.04

Valvular calcification, particularly of the mitral valve or both valves, is a strong independent predictor of all-cause mortality in hemodialysis patients, supporting the use of echocardiography for risk stratification.

Limitations

Limited to hemodialysis patients seen at two high-volume centers
Echocardiograms were performed at a single time point, so some patients may have developed calcification during follow-up
No information on the specific cause of death to assess cardiovascular mortality
Relatively small sample size with wide confidence intervals

Discussion

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Implication

May inform echocardiography-based risk stratification in hemodialysis; hypothesis-generating pending prospective validation.

Cite This Study

Raggi et al. (2011) conducted a cohort in Hemodialysis (CKD-5D) (n=144). Mitral valve calcification vs. No mitral valve calcification was evaluated on All-cause mortality (HR 1.73, 95% CI 1.03 to 2.91, p=0.04). Mitral valve calcification was independently associated with a significantly increased risk of all-cause mortality (HR 1.73) in hemodialysis patients.

synapsesocial.com/papers/6a6f5316f44fa9f079dcbfdf https://doi.org/10.2215/cjn.01140211

Topics

Valvular heart disease

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All-cause Mortality in Hemodialysis Patients with Heart Valve Calcification

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

All-cause Mortality in Hemodialysis Patients with Heart Valve Calcification

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider