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Cardiac Valve Calcification Predicts Mortality In Dialysis Patients
A DGReview of :"Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study."
Journal of the American Society of Nephrology
01/16/2003
By Robert Short
The calcification of cardiac valves is a powerful predictor for mortality and cardiovascular deaths in long-term dialysis patients.
This was the finding of Dr AY Wang and colleagues of the Department of Medicine and Therapeutics and Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
The researchers undertook a prospective study of 192 patients (mean age 55 years) to define the prognostic implication of cardiac valve calcification in long-term peritoneal dialysis patients. There were 46 deaths (half due to cardiovascular causes) in a mean of 17.9 months of follow-up.
Overall, one-year survival was 70% in patients with valvular calcification and 93% for patients without valvular calcification. Cardiovascular mortality was 22% in patients with valvular calcification and just 3% in patients without valvular calcification.
The researchers said, " Multivarible Cox regression analysis showed that cardiac valve calcification was predictive of an increased all-cause mortality and cardiovascular death independent of age, male gender, dialysis duration, C-reactive protein, diabetes, and atherosclerotic vascular disease. The hazard ratio was 2.50 for cardiac valve calcification being predictive of an increased all-cause mortality, and hazard ratio was 5.39 for increased cardiovascular death."
The cardiovascular death rate was 85% for patients with both valvular calcification and atherosclerotic vascular disease, 13% for patients with valvular calcification only, 14% for patients with atherosclerotic vascular disease only, and 5% for those with neither complication (P<0.0005). In addition, the number of calcified valves was associated with all-cause mortality and cardiovascular death.
The researchers concluded, "Valvular calcification by itself has similar prognostic importance as the presence of atherosclerotic vascular disease. Its coexistence with other atherosclerotic complications indicates more severe disease and has the worst outcome."
J Am Soc Nephrol 2003;14(1):159-68.
"Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study."
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