Risk Factors Of Cardiac Valve Calcification In MHD Patients And Its Relationship With CVD And Mortality

Objective Cardiac valve calcification is a common complication in maintenance hemodialysis(MHD)patients.We collected the epidemiological data of MHD patients from January 1,2005 to December 31,2015 in order to explore the risk factors of cardiac valve calcification and the prognosis of MHD patients with valve calcification.Methods The patient’s medical history,primary disease,medication history,demographic data,laboratory and cardiac ultrasound information were collected from January 1,2005 to December 31,2015.According to cardiac ultrasound,MHD patients were classified into CVC group and non-CVC group and according to the prognosis of MHD patients,patients were classified into survival,all-cause mortality and CVD mortality group.Results A total of 511 patients were enrolled,including 318 males(62.0%)and 193 females(37.6%)with the mean age of 59.16 ±14.0 years old.There were a total of 156 cases with cardiac valve calcification.There were 100 patients with aortic valve calcification(AVC),21 patients with mitral valve calcification(MVC),and 35 MHD patients with both AVC and MVC.Non-coronary cups account for 57% of AVC.Posterior leaflet account for 67% of MVC.Patients with CVC were older than nonCVC patients(65.46±12.70 vs 56.47±14.73,P<0.001).The use of phosphate binders in non-CVC group was significantly higher than that in the CVC group(P =0.008).The prevalence of CVC in patients newly initiated into dialysis was similar in different years.Univariate logistic regression analysis revealed that age was a risk factor for cardiac valve calcification.Serum prealbumin level,serum total cholesterol level,the use of phosphate binders and vitamin D were the protective factors for CVC.In order to find the risk factors of the development of cardiac valve calcification,219 patients were enrolled from January 1,2009 to December 31,2013.There were 60 patients with cardiac valve calcification in patients newly initiated into dialysis.There were 53 patients has CVC during the follow-up.Compared with the non-CVC group,the proportion of abnormal CRP in CVC group was significantly higher.Compared with non-CVC group,there was a significantly variability in serum phosphorus level(coefficient of variation 0.26±0.11 vs 0.23±0.08,P=0.023).The variability of serum phosphorus significantly increased the risk of CVC.366 MHD patients completed the follow-up,of which 134 cases with CVC.During the follow-up period,there were 96 cases died and 49 of them died due to CVD.The age of all-cause mortality and CVD mortality was older than survival group.The rate of cardiac valve calcification in death group was significantly higher than that in the survival group.The cumulative survival rate of CVC group in tenth years was only 32% which was far bellower the 63% of non-CVC group.According to the univariate Cox proportional hazards model analysis found age,diabetic nephropathy,CVC,and corrected calcium level were common risk factors of all-cause mortality and CVD mortality.At the same time,serum albumin and prealbumin level were the common protective factors.Multiple factors Cox proportional hazard model showed that age,diabetic nephropathy,CVC and corrected calcium level were independent risk factors for all-cause mortality,whereas diabetic nephropathy,CVC and age were independent risk factors for CVD mortality.Conclusion Hyperphosphatemia,hypocalcaemia,high serum PTH level,the infrequent use of phosphate binders and vitamin D were common in patients newly initiated into dialysis.The variability of phosphorus increased the risk of CVC.Cardiac valve calcification significantly increased the risk of all-cause and CVD mortality.