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Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic Kidney Disease.

Publication ,  Journal Article
Samad, Z; Sivak, JA; Phelan, M; Schulte, PJ; Patel, U; Velazquez, EJ
Published in: J Am Heart Assoc
October 11, 2017

BACKGROUND: Chronic kidney disease (CKD) is an adverse prognostic marker for valve intervention patients; however, the prevalence and related outcomes of valvular heart disease in CKD patients is unknown. METHODS AND RESULTS: Included patients underwent echocardiography (1999-2013), had serum creatinine values within 6 months before index echocardiogram, and had no history of valve surgery. CKD was defined as diagnosis based on the International Classification of Diseases, Ninth Revision or an estimated glomerular filtration rate <60 mL/min per 1.73 m2. Qualitative assessment determined left heart stenotic and regurgitant valve lesions. Cox models assessed CKD and aortic stenosis (AS) interaction for subsequent mortality; analyses were repeated for mitral regurgitation (MR). Among 78 059 patients, 23 727 (30%) had CKD; of these, 1326 were on hemodialysis. CKD patients were older; female; had a higher prevalence of hypertension, hyperlipidemia, diabetes, history of coronary artery bypass grafting/percutaneous coronary intervention, atrial fibrillation, and heart failure ≥mild AS; and ≥mild MR (all P<0.001). Five-year survival estimates of mild, moderate, and severe AS for CKD patients were 40%, 34%, and 42%, respectively, and 69%, 54%, and 67% for non-CKD patients. Five-year survival estimates of mild, moderate, and severe MR for CKD patients were 51%, 38%, and 37%, respectively, and 75%, 66%, and 65% for non-CKD patients. Significant interaction occurred among CKD, AS/MR severity, and mortality in adjusted analyses; the CKD hazard ratio increased from 1.8 (non-AS patients) to 2.0 (severe AS) and from 1.7 (non-MR patients) to 2.6 (severe MR). CONCLUSIONS: Prevalence of at least mild AS and MR is substantially higher and is associated with significantly lower survival among patients with versus without CKD. There is significant interaction among CKD, AS/MR severity, and mortality, with increasingly worse outcomes for CKD patients with increasing AS/MR severity.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

October 11, 2017

Volume

6

Issue

10

Location

England

Related Subject Headings

  • Time Factors
  • Sex Factors
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Proportional Hazards Models
  • Prognosis
  • Prevalence
  • North Carolina
 

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Samad, Z., Sivak, J. A., Phelan, M., Schulte, P. J., Patel, U., & Velazquez, E. J. (2017). Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic Kidney Disease. J Am Heart Assoc, 6(10). https://doi.org/10.1161/JAHA.117.006044
Samad, Zainab, Joseph A. Sivak, Matthew Phelan, Phillip J. Schulte, Uptal Patel, and Eric J. Velazquez. “Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic Kidney Disease.J Am Heart Assoc 6, no. 10 (October 11, 2017). https://doi.org/10.1161/JAHA.117.006044.
Samad Z, Sivak JA, Phelan M, Schulte PJ, Patel U, Velazquez EJ. Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic Kidney Disease. J Am Heart Assoc. 2017 Oct 11;6(10).
Samad, Zainab, et al. “Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic Kidney Disease.J Am Heart Assoc, vol. 6, no. 10, Oct. 2017. Pubmed, doi:10.1161/JAHA.117.006044.
Samad Z, Sivak JA, Phelan M, Schulte PJ, Patel U, Velazquez EJ. Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic Kidney Disease. J Am Heart Assoc. 2017 Oct 11;6(10).
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

October 11, 2017

Volume

6

Issue

10

Location

England

Related Subject Headings

  • Time Factors
  • Sex Factors
  • Severity of Illness Index
  • Risk Factors
  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Proportional Hazards Models
  • Prognosis
  • Prevalence
  • North Carolina