MITRAL ANNULAR CALCIFICATION IN STAGE 5 CHRONIC KIDNEY DISEASE ON DIALYSIS THERAPY
AbstractBackground: Mitral Annular Calcification (MAC) is a degenerative process involving the mitral valve and is a marker of advanced cardiovascular disease. Prevalence in the general population is upto 10% and increases in advanced age, diabetes mellitus, chronic kidney disease (CKD), end stage renal disease (upto 40%) and mitral valve prolapse.The aims of this study were to assess the prevalence of MAC in CKD5D patients and correlate with patients' characteristics. Methods: Echocardiograms were obtained in 84 hemodialysis patients. Association of MAC with various patient characteristics was studied. Data was analysed using SPSS-22. Results: The mean age of the patients was 63.38±12.3 years and 48 (57%) were males. Sixty-eight patients (81%) had DM and 79 (94%) had hypertension. MAC was present in 37 out of 84 (44%) patients. Sixty-four (72%) had IHD. The presence of MAC correlated significantly with IHD (Odds Ratio 6.42, p=0.006). Mean follow up of the patients was 30.30±29.22 months and 37 (44%) suffered mortality during this period. Patients on dialysis for longer than 36 months had an elevated risk of developing MAC (OR=3.32, p=0.019). Patients with the following risk factors: serum PO4 greater than 5.5 (OR=2.03), DM (OR=1.95), HTN (OR=3.35), Age >60 (OR=1.83), AFIB (OR=1.28); had an observable increase in incidence of MAC with time but they weren’t statistically significant. Conclusion: Mitral Annular Calcification is common in hemodialysis patients and correlates significantly with IHD. Our findings support the recommendation by KDIGO 2017 guidelines on Mineral and Bone Disease on the use of echocardiography for the detection of valvular calcification.Keywords: Chronic Kidney Disease; Cardiovascular disease; Mitral Value; Annular calcification
Atar S, Jeon DS, Luo H, Siegel RJ. Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old. Heart 2003;89(2):161–4.
Allam A, Thompson R, Wann S, Miyamoto MI, Nur el-Din A, el-Maksoud GA, et al. Atherosclerosis in Ancient Egyptian Mummies: the Horus Study. JACC Cardiovasc Imaging 2011;(4):315–27.
Fox CS, Vasan RS, Parise H, Levy D, O’Donnell CJ, D’Agostino RB, et al. Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation 2003;107(11):1492–6.
Allison MA, Cheung P, Criqui MH, Langer RD, Wright CM. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation 2006;113(6):861–6.
Savage DD, Garrison RJ, Castelli WP, McNamara PM, Anderson SJ, Kannel WB, et al. Prevalence of submitral (anular) calcium and its correlates in a general population-based sample (the Framingham Study). Am J Cardiol 1983;51(8):1375–8.
Fox E, Harkins D, Taylor H, McMullan M, Han H, Samdarshi T, et al. Epidemiology of mitral annular calcification and its predictive value for coronary events in African Americans: the Jackson Cohort of the Atherosclerotic Risk in Communities Study. Am Heart J 2004;148(6):979–84.
Kanjanauthai S, Nasir K, Katz R, Rivera JJ, Takasu J, Blumenthal RS. Relationships of mitral annular calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2010;213(2):558–62.
Kraus MA, Kalra PA, Hunter J, Menoyo J, Stankus N. The prevalence of vascular calcification in patients with end-stage renal disease on hemodialysis: a cross-sectional observational study. Ther Adv Chronic Dis 2015;6(3):84–96.
Potpara TS, Vasiljevic ZM, Vujisic-Tesic BD, Marinkovic JM, Polovina MM, Stepanovic JM, et al. Mitral annular calcification predicts cardiovascular morbidity and mortality in middle-aged patients with atrial fibrillation: the Belgrade Atrial Fibrillation Study. Chest 2011;140(4):902–10.
United States Renal Data System. 2018 United States Renal Data System Annual Data Report, Volume 2 –ESRD in the United States. [Internet]. [cited 2019 Sep]. Available from: https://www.ajkd.org/article/S0272-6386(19)30028-9/pdf
Maher ER, Young G, Smyth-Walsh B, Pugh S, Curtis JR. Aortic and mitral valve calcification in patients with end-stage renal disease. Lancet 1987;2(8564):875–7.
Sharma R, Pellerin D, Gaze DC, Mehta RL, Gregson H, Streather CP, et al. Mitral annular calcification predicts mortality and coronary artery disease in end stage renal disease. Atherosclerosis 2006;191(2):348–54.
Varma R, Aronow WS, McClung JA, Garrick R, Vistainer PF, Weiss MB, et al. Prevalence of valve calcium and association of valve calcium with coronary artery disease, atherosclerotic vascular disease, and all-cause mortality in 137 patients undergoing hemodialysis for chronic renal failure. Am J Cardiol 2005;95(6):742–3.
KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Am J Kidney Dis 2017;70(6):737–51.
Leskinen Y, Paana T, Saha H, Groundstroem K, Lehtimäki T, Kilpinen S, et al. Valvular calcification and its relationship to atherosclerosis in chronic kidney disease. J Heart Valve Dis 2009;18(4):429–38.
Raggi P, Boulay A, Chasan-Taber S, Amin N, Dillon M, Burke SK, et al. Cardiac Calcification in Adult Hemodialysis Patients A Link Between End-Stage Renal Disease and Cardiovascular Disease? J Am Coll Cardiol 2002;39(4):695–701.
Wang AY, Wang M, Woo J, Lam CW, Li PK, Sanderson JE, et al. Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol 2003;14(1):159–68.
Wang Z, Jiang A, Wei F, Chen H. Cardiac valve calcification and risk of cardiovascular or all-cause mortality in dialysis patients: a meta-analysis. BMC Cardiovasc Disord 2018;18(1):12.
Raggi P, Bellasi A, Gamboa C, Ferramosca E, Ratti C, Block GA, et al. All-cause Mortality in Hemodialysis Patients with Heart Valve Calcification. Clin J Am Soc Nephrol 2011;6(8):1990–5.
Rufino M, García S, Jimenez A, Alvarez A, Miguel R, Delgado P, et al. Heart valve calcification and calcium x phosphorus product in hemodialysis patients: Analysis of optimum values for its prevention. Kidney Int Suppl 2003;64(2):774–5.
Jono S, McKee MD, Murry CE, Shioi A, Nishizawa Y, Mori K, et al. Phosphate regulation of vascular smooth muscle cell calcification. Circ Res 2000;87(7):E10–7.
Block GA. Prevalence and clinical consequences of elevated Ca x P product in hemodialysis patients. Clin Nephrol 2000;54(4):318–24.
Block GA, Wheeler DC, Persky MS, Kestenbaum B, Ketteler M, Spiegel DM, et al. Effects of Phosphate Binders in Moderate CKD. J Am Soc Nephrol 2012;23(8)1407–15.
Russo A, Miranda I, Ruocco C, Battaglia Y, Buonanno E, Manzi S, et al. The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer. J Kidney international 2007;72(10):1255–61.
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