title: Association of cardiac valvular calcifications and C-reactive protein with cardiovascular mortality in incident hemodialysis patients: a Japanese cohort study.
abstract: BACKGROUND
  Cardiac valve calcification is seen frequently in patients undergoing dialysis. Serum C-reactive protein (CRP) level also is reported to predict future cardiovascular events. We investigated the association among valve calcification, CRP level, and mortality in patients with end-stage renal disease who were just beginning hemodialysis (HD) therapy.
  
  
  METHODS
  Observational cohort.
  
  
  METHODS
  1,290 consecutive patients who just started HD therapy were enrolled and were followed up to 10 years.
  
  
  METHODS
  Patients were divided into 3 groups according to number of calcified valves: those without valve calcification, those with calcification in a single (aortic or mitral) valve, and those with calcification in both valves. They also were divided into tertiles according to CRP level.
  
  
  RESULTS
  Cardiovascular and all-cause mortality.
  
  
  METHODS
  Echocardiography and CRP measurement were performed within 1 month after beginning HD therapy.
  
  
  RESULTS
  During follow-up (median, 51 months), 335 (25.9%) patients died, including 156 (12.1%) of cardiovascular disease. The adjusted HR for cardiovascular mortality was 2.80 (95% CI, 1.63-4.81) for 2 calcifications versus 0 (P < 0.001). Furthermore, the risk of cardiovascular mortality was 3.66-fold higher in patients with calcifications in both valves (highest tertile of CRP) compared with patients without valve calcification (lowest tertile of CRP; P < 0.001).
  
  
  CONCLUSIONS
  Precise medical treatments or therapeutic interventions were not evaluated.
  
  
  CONCLUSIONS
  Valve calcification and elevated CRP levels were not only related to additively increased risk of mortality, but also improved the prediction of mortality in patients with end-stage renal disease who had just begun HD therapy.
authors.affiliation: Department of Nephrology, Fujita Health University, Toyoake, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kamoi
authors.forename: Hirotake
authors.initials: H
authors.lastname: Kasuga
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Kaoru
authors.initials: K
authors.lastname: Yasuda
authors.forename: Miho
authors.initials: M
authors.lastname: Tanaka
authors.forename: Daiji
authors.initials: D
authors.lastname: Yoshikawa
authors.forename: Shoichi
authors.initials: S
authors.lastname: Maruyama
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
mesh_terms: D000368:Aged; D044466:Asian People; D002097:C-Reactive Protein / Q000032:analysis*; D002114:Calcinosis / Q000097:blood* / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006349:Heart Valve Diseases / Q000097:blood* / Q000150:complications*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis
chemical_list: D002097:C-Reactive Protein