Cardiac valvular calcification as a marker of atherosclerosis and arterial calcification in end-stage renal disease.
BACKGROUND
Patients with end-stage renal disease (ESRD) are at increased risk for tissue calcifications as a result of deranged mineral metabolism. We tested the hypothesis that valvular calcification is a marker of atherosclerosis in patients with ESRD.


METHODS
Echocardiography was performed in 92 patients undergoing peritoneal dialysis with no background atherosclerotic vascular complications to detect valvular calcification. We used B-mode ultrasonography to determine carotid artery intima-media thickness and the presence of plaque and calcification.


RESULTS
Compared with patients without valvular calcification (n=66), those with valvular calcification (n=26) had higher C-reactive protein levels (P=.01) and greater mean +/- SE carotid intima-media thickness (1.12 +/- 0.06 vs 0.88 +/- 0.04 mm; P=.003). Carotid artery calcification was present unilaterally and bilaterally in 4 patients (15%) and 17 patients (65%) with valvular calcification vs 11 (17%) and 14 (21%) without, respectively (P<.001). Carotid artery plaque was present unilaterally and bilaterally in 11 patients (12%) and 16 patients (65%) with valvular calcification vs 3 (17%) and 17 (24%) without, respectively (P=.001). Using multiple logistic regression analysis, every 1-mm increase in carotid intima-media thickness was independently associated with a 6.51-fold (95% confidence interval, 1.58-26.73; P=.009) increased risk of valvular calcification, and calcification and plaque in the carotid arteries were associated with a 7.18-fold (95% confidence interval, 2.39-21.51; P<.001) and a 5.00-fold (95% confidence interval, 1.77-14.13; P=.002) increased risk of valvular calcification, respectively.


CONCLUSIONS
The associations among valvular calcification, inflammation, carotid atherosclerosis, and arterial calcification suggest that valvular calcification is a marker of atherosclerosis and arterial calcification in patients with ESRD.
Wang
Angela Yee-Moon
AY
Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong. awang@cuhk.edu.hk
Ho
Stella Sin-Yee
SS
Wang
Mei
M
Liu
Eric Kin-Hung
EK
Ho
Simon
S
Li
Philip Kam-Tao
PK
Lui
Siu-Fai
SF
Sanderson
John E
JE
D000704:Analysis of Variance; D001161:Arteriosclerosis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015415:Biomarkers; D002114:Calcinosis / Q000453:epidemiology / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000503:physiopathology*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012306:Risk
D015415:Biomarkers