BACKGROUND: Cardiac valve calcification is seen frequently in patients undergoing dialysis. Serum C-reactive protein (CRP) level also is reported to predict future cardiovascular events. We investigated the association among valve calcification, CRP level, and mortality in patients with end-stage renal disease who were just beginning hemodialysis (HD) therapy. STUDY DESIGN: Observational cohort. SETTING & PARTICIPANTS: 1,290 consecutive patients who just started HD therapy were enrolled and were followed up to 10 years. PREDICTOR: Patients were divided into 3 groups according to number of calcified valves: those without valve calcification, those with calcification in a single (aortic or mitral) valve, and those with calcification in both valves. They also were divided into tertiles according to CRP level. OUTCOMES: Cardiovascular and all-cause mortality. MEASUREMENTS: Echocardiography and CRP measurement were performed within 1 month after beginning HD therapy. RESULTS: During follow-up (median, 51 months), 335 (25.9%) patients died, including 156 (12.1%) of cardiovascular disease. The adjusted HR for cardiovascular mortality was 2.80 (95% CI, 1.63-4.81) for 2 calcifications versus 0 (P < 0.001). Furthermore, the risk of cardiovascular mortality was 3.66-fold higher in patients with calcifications in both valves (highest tertile of CRP) compared with patients without valve calcification (lowest tertile of CRP; P < 0.001). LIMITATIONS: Precise medical treatments or therapeutic interventions were not evaluated. CONCLUSIONS: Valve calcification and elevated CRP levels were not only related to additively increased risk of mortality, but also improved the prediction of mortality in patients with end-stage renal disease who had just begun HD therapy.
BACKGROUND:Cardiac valve calcification is seen frequently in patients undergoing dialysis. Serum C-reactive protein (CRP) level also is reported to predict future cardiovascular events. We investigated the association among valve calcification, CRP level, and mortality in patients with end-stage renal disease who were just beginning hemodialysis (HD) therapy. STUDY DESIGN: Observational cohort. SETTING & PARTICIPANTS: 1,290 consecutive patients who just started HD therapy were enrolled and were followed up to 10 years. PREDICTOR: Patients were divided into 3 groups according to number of calcified valves: those without valve calcification, those with calcification in a single (aortic or mitral) valve, and those with calcification in both valves. They also were divided into tertiles according to CRP level. OUTCOMES: Cardiovascular and all-cause mortality. MEASUREMENTS: Echocardiography and CRP measurement were performed within 1 month after beginning HD therapy. RESULTS: During follow-up (median, 51 months), 335 (25.9%) patients died, including 156 (12.1%) of cardiovascular disease. The adjusted HR for cardiovascular mortality was 2.80 (95% CI, 1.63-4.81) for 2 calcifications versus 0 (P < 0.001). Furthermore, the risk of cardiovascular mortality was 3.66-fold higher in patients with calcifications in both valves (highest tertile of CRP) compared with patients without valve calcification (lowest tertile of CRP; P < 0.001). LIMITATIONS: Precise medical treatments or therapeutic interventions were not evaluated. CONCLUSIONS:Valve calcification and elevated CRP levels were not only related to additively increased risk of mortality, but also improved the prediction of mortality in patients with end-stage renal disease who had just begun HD therapy.
Authors: Sharanya Ramesh; Ann Zalucky; Brenda R Hemmelgarn; Derek J Roberts; Sofia B Ahmed; Stephen B Wilton; Min Jun Journal: BMC Nephrol Date: 2016-07-11 Impact factor: 2.388
Authors: Paul Anaya; Gustav A Blomquist; Daniel L Davenport; Marie-Claude Monier-Faugere; Vincent L Sorrell; Hartmut H Malluche Journal: Clin Nephrol Date: 2016-12 Impact factor: 0.975
Authors: Luca Di Lullo; Antonio Gorini; Antonio Bellasi; Luigi F Morrone; Rodolfo Rivera; Luigi Russo; Alberto Santoboni; Domenico Russo Journal: Clin Kidney J Date: 2015-09-03