Prevalence and Outcomes of Left-Sided Valvular Heart Disease Associated With Chronic Kidney Disease.
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2017-10-11
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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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Samad, Zainab, Joseph A Sivak, Matthew Phelan, Phillip J Schulte, Uptal Patel and Eric J Velazquez (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.
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Zainab Samad
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 training in cardiovascular imaging, specifically in clinical echocardiography, cardiac MRI and SPECT-myocardial perfusion imaging. She is also trained in quantitative methods with a Master of Health Sciences in Clinical Research degree from the National Institutes of Health- Duke Clinical Research Training Program. She served on faculty in the Division of Cardiology, Department of Medicine for nine years before accepting the position at AKU in 2018. She resides full-time in Karachi.
Uptal Dinesh Patel
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. He has led clinical and translational research programs to improve detection and management of kidney disease in a variety of populations.
His current efforts seek to advance targeted therapies for immune-mediated diseases as the Senior Vice President and Head of Development at HI-Bio, at Biogen. Prior to being CMO at HI-Bio, he led clinical strategy, translation, and development of the kidney portfolios at AstraZeneca (within the early cardiovascular, renal, and metabolism therapeutic area) and Gilead Sciences (within the inflammation therapeutic area).
He currently also serves as Chair of the Board of Directors for the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and the FDA to catalyze innovation and the development of safe and effective patient-centered therapies for people with kidney diseases. He completed training at the University of Michigan in internal medicine, pediatrics, adult nephrology, pediatric nephrology, and health services research after attending medical school at UCSF.
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