title: All-cause mortality in hemodialysis patients with heart valve calcification.
abstract: OBJECTIVE
  Calcification of the mitral and aortic valves is common in dialysis patients (CKD-5D). However, the prognostic significance of valvular calcification (VC) in CKD is not well established.
  
  
  METHODS
  144 adult CKD-5D patients underwent bidimensional echocardiography for qualitative assessment of VC and cardiac computed tomography (CT) for quantification of coronary artery calcium (CAC) and VC. The patients were followed for a median of 5.6 years for mortality from all causes.
  
  
  RESULTS
  Overall, 38.2% of patients had mitral VC and 44.4% had aortic VC on echocardiography. Patients with VC were older and less likely to be African American; all other characteristics were similar between groups. The mortality rate of patients with calcification of either valve was higher than for patients without VC. After adjustment for age, gender, race, diabetes mellitus, and history of atherosclerotic disease, only mitral VC remained independently associated with all-cause mortality (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.03 to 2.91). Patients with calcification of both valves had a two-fold increased risk of death during follow-up compared with patients without VC (HR, 2.16; 95% CI, 1.14 to 4.08). A combined CT score of VC and CAC was strongly associated with all-cause mortality during follow-up (HR for highest versus lowest tertile, 2.21; 95% CI, 1.08 to 4.54).
  
  
  CONCLUSIONS
  VC is associated with a significantly increased risk for all-cause mortality in CKD-5D patients. These findings support the use of echocardiography for risk stratification in CKD-5D as recently suggested in the Kidney Disease Improving Global Outcomes guidelines.
authors.affiliation: 1365 Clifton Road NE, Suite AT-504, Atlanta, GA 30322, USA. praggi@emory.edu
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellasi
authors.forename: Christopher
authors.initials: C
authors.lastname: Gamboa
authors.forename: Emiliana
authors.initials: E
authors.lastname: Ferramosca
authors.forename: Carlo
authors.initials: C
authors.lastname: Ratti
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Block
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000175:diagnosis / Q000401:mortality*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D014481:United States