Valvular calcification, inflammation, and mortality in dialysis patients.
OBJECTIVE
The study aim was to determine the correlates of valvular calcification (VC), including clinical and physiologic parameters, in individuals new to dialysis. In addition, the association of VC with coronary artery calcification (CAC) progression and mortality was investigated.


METHODS
A total of 101 incident dialysis individuals underwent electrocardiogram-triggered multislice computed tomography (CT) to monitor the presence and quantification of calcification. The average follow up was 2.85 +/- 0.72 years.


RESULTS
Twenty-six (25.7%) patients had only one valve calcified, while 10 (9.9%) had calcifications in both valves. Patients with VC were older, more likely to have a history of diabetes and/or cardiovascular disease (CVD), more likely to have CAC, and to be Caucasian; fibrinogen and interleukin-6 (IL-6) levels were also higher in these patients. Multivariable Poisson regression analysis revealed older age, history of CVD, increasing fibrinogen, and presence of CAC were independently associated with the presence of VC. Patients with VC also had a higher median annualized CAC progression compared to those without VC (2.90 versus 105.2, p = 0.004). The mortality rate per 100 years was 2.57 in patients without VC, compared to 4.20 and 13.76, respectively, for those with one or two calcified valves. An increasing number of calcified valves was associated with a higher mortality after adjustment for gender and race [HR 2.2 (1.03-4.69), p = 0.04], but was not statistically significant after adjustment for inflammatory markers such as IL-6 or fibrinogen.


CONCLUSIONS
Traditional and novel risk factors are associated with the presence of VC, which is a risk marker for CAC progression and mortality in incident dialysis patients.
Department of Medicine, Pennsylvania Hospital, Philadelphia, USA.
Bonita A
BA
Mohamed
Wei
W
Yang
Harold
H
Litt
Sylvia E
SE
Rosas
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000150:complications / Q000378:metabolism / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006349:Heart Valve Diseases / Q000150:complications / Q000378:metabolism / Q000473:pathology; D006351:Heart Valves / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis / Q000401:mortality / Q000706:statistics & numerical data*; D013223:Statistics as Topic; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D060749:alpha-2-HS-Glycoprotein / Q000032:analysis
D015850:Interleukin-6; D060749:alpha-2-HS-Glycoprotein; D005340:Fibrinogen