title: De novo development of heart valve calcification in incident peritoneal dialysis patients.
abstract: OBJECTIVE
  Cardiac valve calcification (VC) is a frequent complication in chronic kidney disease and is considered a risk factor for all-cause and cardiovascular mortality. However, little is known about the pathophysiology mechanisms that originate it and the factors associated with its development. We undertook this study to analyze the frequency and factors related to de novo development of mitral valve calcification (MVC) and aortic valve calcifications (AVC) in incident peritoneal dialysis (PD) patients.
  
  
  METHODS
  A prospective cohort of 124 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1 year of follow-up for calcium, phosphorus, glucose, urea, creatinine, cholesterol, triglycerides by spectrophotometry assay; high-sensitivity C-reactive protein (CRP) by immunoturbidimetric ultrasensitive assay, intact parathormone (iPTH) and osteocalcin by electrochemiluminescence, fetuin-A and osteoprotegerin by EDI-ELISA. Valve calcification was evaluated by M-mode bidimensional echocardiogram.
  
  
  RESULTS
  Sixty eight percent of patients were male, ages 43 ± 13 years; 51% were diabetic with 1.4 ± 1 months on PD. After 12.3 ± 1 months, 57 patients (46%) developed VC: AVC in 33 (57.8%), MVC in 15 (26.3%) and 9 (15.8%) patients in both valves. There was no correlation between AVC and MCV. In univariate logistic regression analysis, age, diabetes and elevated concentrations of OPG, iPTH and CRP were risk factors for development MVC. In multivariate analysis, only iPTH remained an independent risk factor as was also the case in AVC.
  
  
  CONCLUSIONS
  Age, diabetes, osteoprotegerin, parathormone and C-reactive protein are risk factors related to de novo development of MVC and iPTH for AVC in incident dialysis patients.
authors.affiliation: Medical Research Unit in Nephrology Diseases, CMNS XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico, D.F., Mexico. Electronic address: cramav@gmail.com.
authors.forename: Marcela
authors.initials: M
authors.lastname: Avila-Díaz
authors.forename: Carmen
authors.initials: C
authors.lastname: Mora-Villalpando
authors.forename: Ma Del Carmen
authors.initials: Mdel C
authors.lastname: Prado-Uribe
authors.forename: Oscar
authors.initials: O
authors.lastname: Orihuela-Rodriguez
authors.forename: Edgar
authors.initials: E
authors.lastname: Villegas-Antelo
authors.forename: Ana Ma
authors.initials: AM
authors.lastname: Gómez-Noriega
authors.forename: Diana
authors.initials: D
authors.lastname: Villanueva-Noches
authors.forename: Hector
authors.initials: H
authors.lastname: Hinojosa-Heredia
authors.forename: Héctor
authors.initials: H
authors.lastname: Hinojosa-Hernandez
authors.forename: Juan
authors.initials: J
authors.lastname: Serrato-Avila
authors.forename: Begoña
authors.initials: B
authors.lastname: Ilabaca
authors.forename: Ramón
authors.initials: R
authors.lastname: Paniagua
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006349:Heart Valve Diseases / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000378:metabolism / Q000503:physiopathology*; D044162:Parathyroid Hormone-Related Protein / Q000009:adverse effects / Q000097:blood; D010530:Peritoneal Dialysis / Q000009:adverse effects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors
chemical_list: D044162:Parathyroid Hormone-Related Protein; D002097:C-Reactive Protein
keywords: Cardiovascular disease; Chronic kidney disease; Diabetes; Heart valve calcification; Mineral metabolism; Peritoneal dialysis