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Am J Kidney Dis. 2013 Feb;61(2):254-61. doi: 10.1053/j.ajkd.2012.09.007. Epub 2012 Nov 2.

Association of cardiac valvular calcifications and C-reactive protein with cardiovascular mortality in incident hemodialysis patients: a Japanese cohort study.

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1
Department of Nephrology, Fujita Health University, Toyoake, Japan.

Abstract

BACKGROUND:

Cardiac valve calcification is seen frequently in patients undergoing dialysis. Serum C-reactive protein (CRP) level also is reported to predict future cardiovascular events. We investigated the association among valve calcification, CRP level, and mortality in patients with end-stage renal disease who were just beginning hemodialysis (HD) therapy.

STUDY DESIGN:

Observational cohort.

SETTING & PARTICIPANTS:

1,290 consecutive patients who just started HD therapy were enrolled and were followed up to 10 years.

PREDICTOR:

Patients were divided into 3 groups according to number of calcified valves: those without valve calcification, those with calcification in a single (aortic or mitral) valve, and those with calcification in both valves. They also were divided into tertiles according to CRP level.

OUTCOMES:

Cardiovascular and all-cause mortality.

MEASUREMENTS:

Echocardiography and CRP measurement were performed within 1 month after beginning HD therapy.

RESULTS:

During follow-up (median, 51 months), 335 (25.9%) patients died, including 156 (12.1%) of cardiovascular disease. The adjusted HR for cardiovascular mortality was 2.80 (95% CI, 1.63-4.81) for 2 calcifications versus 0 (P < 0.001). Furthermore, the risk of cardiovascular mortality was 3.66-fold higher in patients with calcifications in both valves (highest tertile of CRP) compared with patients without valve calcification (lowest tertile of CRP; P < 0.001).

LIMITATIONS:

Precise medical treatments or therapeutic interventions were not evaluated.

CONCLUSIONS:

Valve calcification and elevated CRP levels were not only related to additively increased risk of mortality, but also improved the prediction of mortality in patients with end-stage renal disease who had just begun HD therapy.

PMID:
23122492
DOI:
10.1053/j.ajkd.2012.09.007
[Indexed for MEDLINE]

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