Predictive value of mitral and aortic valve sclerosis for survival in end-stage renal disease on continuous ambulatory peritoneal dialysis.
To determine whether mitral valve or anular sclerosis or calcification (MC) is associated with reduced survival in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), 53 CAPD patients were followed with echocardiography and Doppler echocardiography over 35 months. Both nonsurvivors and survivors with MC had higher systolic blood pressure before CAPD and calcium-phosphorus products during CAPD treatment than patients without MC (p < 0.05). Serum calcium and phosphorus concentrations, alkaline phosphatase and parathyroid hormone activities were higher in nonsurvivors and survivors with than without MC (p > 0.05). Left ventricular end-diastolic and end-systolic volumes were greater (p < 0.01), ejection fractions were smaller (p < 0.05) in nonsurvivors with than without MC, but not in survivors with versus without MC. Severe MC and grade III mitral valve regurgitation were more frequent in nonsurvivors than in survivors (p < 0.03). No valvular stenoses were found. It is concluded that the development of MC is favored by long-standing predialysis arterial hypertension and by high calcium-phosphorus products during CAPD. Nonsurvivors with MC are characterized by reduced systolic left ventricular function or severe valvular lesions. A close cardionephrologic cooperation is necessary to improve the survival of CAPD patients with these risk factors.
Hüting
J
J
University of Giessen Medical School, Department of Internal Medicine, FRG.
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000473:pathology; D002114:Calcinosis / Q000209:etiology; D006332:Cardiomegaly / Q000150:complications; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology; D006351:Heart Valves / Q000473:pathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D012307:Risk Factors; D012598:Sclerosis