title: Aortic and mitral valve disease in patients with end stage renal failure on long-term haemodialysis.
abstract: OBJECTIVE
  To identify valvar heart disease in patients with chronic uraemia by conventional and colour coded Doppler echocardiography.
  
  
  METHODS
  Case series of an unselected group of 62 patients with end stage renal failure.
  
  
  METHODS
  Centre for haemodialysis in a referral hospital in Switzerland.
  
  
  METHODS
  62 patients on chronic haemodialysis.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Kantonsspital Aarau, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Straumann
authors.forename: B
authors.initials: B
authors.lastname: Meyer
authors.forename: M
authors.initials: M
authors.lastname: Misteli
authors.forename: A
authors.initials: A
authors.lastname: Blumberg
authors.forename: H R
authors.initials: HR
authors.lastname: Jenzer
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D001021:Aortic Valve; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D010281:Parathyroid Hormone / Q000097:blood; D010808:Physical Examination; D006435:Renal Dialysis; D012680:Sensitivity and Specificity
chemical_list: D010281:Parathyroid Hormone; D000469:Alkaline Phosphatase