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Abstract: FR-PO264

Aortic Valve Calcification (AVC) Is Associated with All-Cause Mortality Independent of Coronary Artery Calcification (CAC) in Patients with ESRD

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Dai, Lu, Karolinska Institutet, Stockholm, Sweden
  • Plunde, Oscar, Karolinska University Hospital, Stockholm, Sweden
  • Qureshi, Abdul Rashid Tony, Karolinska Institutet, Stockholm, Sweden
  • Lindholm, Bengt, Karolinska Institutet, Stockholm, Sweden
  • Brismar, Torkel Bo, Karolinska University Hospital, Stockholm, Sweden
  • Ripsweden, Jonaz, Karolinska University Hospital, Stockholm, Sweden
  • Bäck, Magnus, Karolinska University Hospital, Stockholm, Sweden
  • Stenvinkel, Peter, Karolinska Institutet, Stockholm, Sweden
Background

AVC is common in ESRD patients (pts). However, the prognostic significance of the overlap between AVC and CAC in ESRD is not well established. We investigated whether AVC is associated with all-cause mortality independent of CAC in ESRD pts.

Methods

259 ESRD pts (median age 55 years, 67% males) undergoing cardiac CT for AVC and CAC scoring (Agatston units) were included. Framingham’s score (FRS), presence of cardiovascular disease (CVD), statin use, protein energy wasting (PEW, subjective global assessment), high-sensitivity C-reactive protein (hsCRP) and other relevant biochemistry and demographic data were determined at baseline. During follow-up for median 36 months, 44 (17%) pts died, and 68 pts underwent renal transplantation. Descriptive, multivariate logistic regression for determinants of AVC, and competing-risk regression analysis for AVC vs all-cause mortality, were performed to define the role of AVC in clinical outcome.

Results

Based on presence (+) or absence (-) of AVC and CAC at baseline, pts were divided into four groups: AVC (-) CAC (-), n=72, 28%; AVC (+) CAC (-), n=5, 2%; AVC (-) CAC (+), n=87, 33%; AVC (+) CAC (+), n=95, 37%. Pts with AVC had older age, higher BMI, more comorbidities, higher FRS, more statin use, lower hand grip strength, higher triglycerides and higher hsCRP. FRS (odds ratio [OR 2.25; 95% confidence interval [95%CI], 1.43 to 3.55] and CAC score (OR [95%CI], 2.18[1.34 to 3.59]) were identified as independent determinants of AVC. After adjustment for presence of CAC, inflammation (hsCRP >10 mg/L), PEW, CVD, 1-SD of FRS and statin use, AVC remained independently associated with all-cause mortality (subdistribution hazard ratio, SHR [95%CI] 2.57 [1.20 to 5.51]) while CAC lost its significant association with mortality (SHR [95%CI], 2.25 [0.46 to 11.01]).

Conclusion

The overlap of AVC and CAC was three times higher (37% vs 11 % ) in this ESRD cohort than such overlap previously reported in general population. AVC associated with increased risk of all-cause mortality in ESRD pts, independent of presence of CAC, traditional risk factors and inflammation.

Funding

  • Commercial Support