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Kidney Week

Abstract: PO1227

Valvular Heart Disease in Prevalent Haemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Elewa, Mohamed, Manchester University NHS Foundation Trust, Manchester, United Kingdom
  • Jayanti, Anuradha, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, United Kingdom
Background

Valvular heart disease is observed in patients with Chronic Kidney Disease. Previous large studies found a prevalence rate of 14%-16% of valvular heart disease (VHD) in haemodialysis patients (2018 USRDS; Hickson et al., 2016). KDIGO consensus group identified several evidence gaps where research is necessary in order to improve our understanding of diagnosis and management of VHD. The aim of our study is to assess the burden of VHD in a haemodialysis cohort in one center in the UK.

Methods

A single-center; retrospective, cross-sectional study of echocardiographic findings in prevalent haemodialysis patients. Patients were considered to have VHD if they had significant aortic or mitral valve disease (AVD, MVD) based on standard echocardiographic criteria. Medical records were reviewed for clinical information.

Results

This study included 425 haemodialysis recipients. Mean age was 61 years, (SD: 14.96). The cohort was predominantly male (59.3%). The mean BMI was 27.69 (SD: 5.99). 37.1% had a history of smoking. The median renal replacement therapy vintage was 3.19 years [IQR: 1.99, 6.33], with median haemodialysis vintage of 2.93 years [IQR: 1.76, 5]. 83% of patients had hypertension, 41% had diabetes, 29% had coronary artery disease (CAD) and 13% had a history of congestive cardiac failure (CCF). Atrial Fibrillation (AF) was present in 11.5%.

34% (n=143) had evidence of VHD. 18% had evidence of AVD (n=78); Aortic Regurgitation in 11%, and Aortic Stenosis in 7% of patients. 20% of patients (n=85) had MVD with Mitral Regurgitation in 18% of patients and Mitral Stenosis in 0.7% (n=3). 5% of patients had cardiothoracic intervention (n=21) for VHD.

Compared to patients who had no evidence of VHD, those with VHD were significantly older (p <0.001), had lower relative BMI (p=0.001), and had co-existing AF, CAD and CCF (p<0.05). These patients had a significantly longer dialysis vintage (p=0.001). Patients, who had VHD, had a tendency to higher serum calcium, although this did not reach statistical significance (p=0.057). Similarly, diabetes was also higher in the non-VHD cohort (44.3% vs 34.3%, p=0.059).

Conclusion

34% of patients had significant VHD, higher than the previously published figures. The lower prevalence of diabetes in the VHD cohort makes the metabolic milieu an additional important risk factor in VHD. Timely echocardiographic studies are essential to identify patients with significant VHD.