Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic Kidney Disease.
Abstract
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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https://hdl.handle.net/10161/16077Published Version (Please cite this version)
10.1161/JAHA.117.006044Publication Info
Samad, Zainab; Sivak, Joseph A; Phelan, Matthew; Schulte, Phillip J; Patel, Uptal;
& Velazquez, Eric J (2017). Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic
Kidney Disease. J Am Heart Assoc, 6(10). 10.1161/JAHA.117.006044. Retrieved from https://hdl.handle.net/10161/16077.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Uptal Dinesh Patel
Adjunct Professor in the Department of Medicine
Uptal Patel, MD is an Adjunct Professor interested in population health with a broad
range of clinical and research experience. As an adult and pediatric nephrologist
with training in health services and epidemiology, his work seeks to improve population
health for patients with kidney diseases through improvements in prevention, diagnosis
and treatment. Prior efforts focused on four inter-related areas that are essential
to improving kidney health: i) reducing the progressi
Zainab Samad
Adjunct Associate Professor in the Department of Medicine
Dr. Zainab Samad is chairwoman of the Department of Medicine at Aga Khan University
(AKU) in Pakistan and currently serves as an Adjunct Associate Professor of Medicine
at Duke University. She attended Medical School at the Aga Khan University Medical
College in Karachi, Pakistan and thereafter completed her residency training in Internal
Medicine and fellowship in Cardiology at Duke University Medical Center in Durham,
North Carolina. Additionally, she completed advanced tra
Eric J. Velazquez
Adjunct Professor in the Department of Medicine
LeadershipEric J. Velazquez, MD, is a Professor of Medicine with tenure at Duke University.
As section chief for Cardiovascular Imaging in the Division of Cardiology and director
of the Cardiac Diagnostic Unit and Echocardiography Laboratories for Duke University
Health System, he coordinates a high-volume enterprise and an outstanding group of
clinician-investigators and clinical staff who make important contributions across
patient care, research and educational
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