title: Parathyroid hormone and systolic blood pressure accelerate the progression of aortic valve stenosis in chronic hemodialysis patients.
abstract: BACKGROUND
  Aortic valve stenosis (AS) is a frequent complication contributing to poor prognosis in chronic hemodialysis (CHD) patients. However, little is known regarding the risk factors affecting AS progression. The purpose of this study was to define risk factors affecting AS progression in CHD patients.
  
  
  METHODS
  We retrospectively investigated 34 consecutive CHD patients with asymptomatic AS (mild in 9, moderate in 20, severe in 5; aortic valve area (AVA), 1.31±0.31cm(2); mean age, 69±8years) who underwent followed-up paired transthoracic echocardiography with period of at least six months apart (22±9months). AS progression was evaluated using the absolute reduction in AVA per year.
  
  
  RESULTS
  CHD patients were divided into 20 patients with rapid progression (AVA reduction, >0.1cm(2) per year) and 14 with slow progression (AVA reduction, ≤ 0.1cm(2) per year). Serum parathyroid hormone (PTH) level was significantly higher in patients with rapid progression than in those with slow progression [343±489pg/ml vs. 76±80pg/ml, P<0.05]. In univariate analysis, AS progression by absolute AVA reduction per year was associated with age, PTH level, initial AVA, systolic blood pressure (SBP), diastolic blood pressure, total cholesterol, and left ventricular diameter at end-diastole and end-systole. Multiple regression analysis indicated that serum PTH level and SBP remained independently associated with AS progression.
  
  
  CONCLUSIONS
  AS progression was accelerated in the presence of high PTH and SBP. Careful monitoring and intensive treatment of these parameters may have a beneficial effect on secondary prevention in CHD patients.
authors.affiliation: Fuchu Hospital, Osaka, Japan. Electronic address: shiniwashinshin@gmail.com.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwata
authors.affiliation: Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Hyodo
authors.affiliation: Fuchu Hospital, Osaka, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Yanagi
authors.affiliation: Fuchu Hospital, Osaka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Fuchu Hospital, Osaka, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Nishiyama
authors.affiliation: Fuchu Hospital, Osaka, Japan.
authors.forename: Kimio
authors.initials: K
authors.lastname: Kamimori
authors.affiliation: Fuchu Hospital, Osaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ota
authors.affiliation: Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsumura
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.affiliation: Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000453:epidemiology / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D002908:Chronic Disease; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D006435:Renal Dialysis / Q000639:trends*; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone