Hospitalized valvular heart disease in patients on renal transplant waiting list: incidence, clinical correlates and outcomes.
BACKGROUND
Patients with ESRD are at increased risk for heart valve calcification. It has not been established whether hospitalized valvular heart disease (VHD) is a substantial barrier to renal transplantation (RT) after transplant listing, or whether VHD progresses after RT.


METHODS
Using data from the USRDS, we studied 35,215 patients with ESRD enrolled on the renal transplant waiting list from July 1994 to June 1997. Cox non-proportional hazards regression models were used to calculate adjusted, time-dependent hazard ratios (HR) for RT and VHD.


RESULTS
In comparison to maintenance dialysis (2.2/1,000 person years), RT was independently associated with a lower hazard for hospitalization for VHD (0.7/1,000 person years, HR 0.28, 95% confidence interval 0.17 - 0.47). Renal transplant recipients had much lower rates of VHD after transplant than before (rate ratio (RR) 0.49, 95% Cl 0.47 - 0.52). Patients with VHD were significantly less likely to receive RT (adjusted rate for RT 0.38, 95% CI 0.20 - 0.45) but patients who received valve replacement surgeries (VRS) were not affected (adjusted rate for RT 1.10, 95% CI 0.52 - 2.32, not significant).


CONCLUSIONS
VHD is an uncommon but serious barrier to RT after listing, while VRS is not a significant barrier to RT. Established VHD does not appear to worsen after RT. Clinicians should consider giving increased attention to the detection and treatment of VHD during the pre-transplant evaluation.
Abbott
K C
KC
Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. kevin.abbott@na.amedd.army.mil
Hshieh
P
P
Cruess
D
D
Agodoa
L Y C
LY
Welch
P G
PG
Taylor
A J
AJ
Yuan
C M
CM
D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D015999:Multivariate Analysis; D012042:Registries; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists