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Cited by 128Cardiac Valve Diseases and TreatmentsInfective Endocarditis Diagnosis and ManagementCardiovascular Function and Risk Factors

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

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Samad, Zainab, Sivak, Joseph A., Phelan, Matthew, Schulte, Phillip J., Patel, Uptal, Velazquez, Eric J.·2017·Journal of the American Heart Association
DOI 10.1161/jaha.117.006044PMC PMC5721834
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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 m 2 . 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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  • Structural heart diseases are often diagnosed after the development of clinical symptoms, leading to poor health outcomes.

    “Consequently, these conditions are often diagnosed after the development of clinical symptoms, leading to poor health outcomes.4-6”

    From Ensemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images (2025) · cites this paper as [5]

    The Conclusions report that left-sided valve disease is associated with higher mortality among patients with CKD, supporting the poor-outcomes portion for that population. Neither the Conclusions nor the Discussion’s Clinical Implications section says these conditions are often diagnosed only after symptoms develop, or that delayed diagnosis causes the poor outcomes. (LLM, conf=0.82)

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  1. [1]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: 875– 877. 2889080
  2. [2]Maher ER, Curtis JR. Calcific aortic stenosis in chronic renal failure. Lancet. 1985; 2: 1007. 2865472
  3. [3]Masuda C, Dohi K, Sakurai Y, Bessho Y, Fukuda H, Fujii S, Sugimoto T, Tanabe M, Onishi K, Shiraki K, Ito M, Nobori T. Impact of chronic kidney disease on the presence and severity of aortic stenosis in patients at high risk for coronary artery disease. Cardiovasc Ultrasound. 2011; 9: 31. 22087774 PMC3228740
  4. [4]Zentner D, Hunt D, Chan W, Barzi F, Grigg L, Perkovic V. Prospective evaluation of aortic stenosis in end‐stage kidney disease: a more fulminant process? Nephrol Dial Transplant. 2011; 26: 1651– 1655. 20876599
  5. [5]Sharma R, Pellerin D, Gaze DC, Mehta RL, Gregson H, Steather CP, Collinson PO, Brecker SJ. Mitral annular calcification predicts mortality and coronary artery disease in end stage renal disease. Atherosclerosis. 2007; 191: 348– 354. 16647710
  6. [6]Ix JH, Shlipak MG, Katz R, Budoff MJ, Shavelle DM, Probstfield JL, Takasu J, Detrano R, O'Brien KD. Kidney function and aortic valve and mitral annular calcification in the Multi‐Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis. 2007; 50: 412– 420. 17720520
  7. [7]Rankin JS, Hammill BG, Ferguson TB Jr, Glower DD, O'Brien SM, DeLong ER, Peterson ED, Edwards FH. Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg. 2006; 131: 547– 557. 16515904
  8. [8]Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, Fontana GP, Dewey TM, Thourani VH, Pichard AD, Fischbein M, Szeto WY, Lim S, Greason KL, Teirstein PS, Malaisrie SC, Douglas PS, Hahn RT, Whisenant B, Zajarias A, Wang D, Akin JJ, Anderson WN, Leon MB; PARTNER Trial Investigators. Two‐year outcomes after transcatheter or surgical aortic‐valve replacement. N Engl J Med. 2012; 366: 1686– 1695. 22443479
  9. [9]Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, Thourani VH, Babaliaros VC, Webb JG, Herrmann HC, Bavaria JE, Kodali S, Brown DL, Bowers B, Dewey TM, Svensson LG, Tuzcu M, Moses JW, Williams MR, Siegel RJ, Akin JJ, Anderson WN, Pocock S, Smith CR, Leon MB; PARTNER Trial Investigators. Transcatheter aortic‐valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012; 366: 1696– 1704. 22443478
  10. [10]Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD; ACC/AHA Task Force Members. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129: e521– e643. 24589853
  11. [11]Whitlow PL, Feldman T, Pedersen WR, Lim DS, Kipperman R, Smalling R, Bajwa T, Herrmann HC, Lasala J, Maddux JT, Tuzcu M, Kapadia S, Trento A, Siegel RJ, Foster E, Glower D, Mauri L, Kar S; EVEREST II Investigators. Acute and 12‐month results with catheter‐based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edge‐to‐Edge Repair) High Risk Study. J Am Coll Cardiol. 2012; 59: 130– 139. 22222076
  12. [12]Ersboll M, Schulte PJ, Al Enezi F, Shaw L, Køber L, Kisslo J, Siddiqui I, Piccini J, Glower D, Harrison JK, Bashore T, Risum N, Jollis JG, Velazquez EJ, Samad Z. Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction. Am J Cardiol. 2015; 115: 86– 92. 25456876
  13. [13]Velazquez EJ, Samad Z, Al‐Khalidi HR, Sangli C, Grayburn PA, Massaro JM, Stevens SR, Feldman TE, Krucoff MW. The MitraClip and survival in patients with mitral regurgitation at high risk for surgery: a propensity‐matched comparison. Am Heart J. 2015; 170: 1050– 1059.e3. 26542516
  14. [14]Samad Z, Shaw LK, Phelan M, Ersboll M, Risum N, Al‐Khalidi HR, Glower DD, Milano CA, Alexander JH, O'Connor CM, Wang A, Velazquez EJ. Management and outcomes in patients with moderate or severe functional mitral regurgitation and severe left ventricular dysfunction. Eur Heart J. 2015; 36: 2733– 2741. 26233850
  15. [15]Horvath MM, Winfield S, Evans S, Slopek S, Shang H, Ferranti J. The DEDUCE Guided Query tool: providing simplified access to clinical data for research and quality improvement. J Biomed Inform. 2011; 44: 266– 276. 21130181 PMC3063322
  16. [16]Mark DB, Nelson CL, Califf RM, Harrell FE Jr, Lee KL, Jones RH, Fortin DF, Stack RS, Glower DD, Smith LR, DeLong ER, Smith PK, Reves JG, Jollis JG, Tcheng JE, Muhlbaier LH, Lowe JE, Phillips HR, Pryor DB. Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty. Circulation. 1994; 89: 2015– 2025. 8181125
  17. [19]Boyle CA, Decouflé P. National sources of vital status information: extent of coverage and possible selectivity in reporting. Am J Epidemiol. 1990; 131: 160– 168. 2403466
  18. [21]Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, White HD, Nordlander R, Maggioni A, Dickstein K, Zelenkofske S, Leimberger JD, Califf RM, Pfeffer MA. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004; 351: 1285– 1295. 15385655
  19. [22]Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004; 351: 1296– 1305. 15385656
  20. [23]Parikh NI, Hwang SJ, Larson MG, Meigs JB, Levy D, Fox CS. Cardiovascular disease risk factors in chronic kidney disease: overall burden and rates of treatment and control. Arch Intern Med. 2006; 166: 1884– 1891. 17000946
  21. [24]Han JH, Han JS, Kim EJ, Doh FM, Koo HM, Kim CH, Lee MJ, Oh HJ, Park JT, Han SH, Ryu DR, Yoo TH, Kang SW. Diastolic dysfunction is an independent predictor of cardiovascular events in incident dialysis patients with preserved systolic function. PLoS One. 2015; 10: e0118694. 25739020 PMC4349827
  22. [25]Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis. 1996; 27: 347– 354. 8604703
  23. [26]Silberberg JS, Barre PE, Prichard SS, Sniderman AD. Impact of left ventricular hypertrophy on survival in end‐stage renal disease. Kidney Int. 1989; 36: 286– 290. 2528654
  24. [27]Virga G, Stomaci B, Munaro A, Mastrosimone S, Cara M, Artuso E, Piovesana P. Systolic and diastolic function in renal replacement therapy: a cross‐sectional study. J Nephrol. 2006; 19: 155– 160. 16736413
  25. [28]Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Ford CE, Shulman NB, Stamler J. Blood pressure and end‐stage renal disease in men. N Engl J Med. 1996; 334: 13– 18. 7494564
  26. [29]Ruggenenti P, Perna A, Loriga G, Ganeva M, Ene‐Iordache B, Turturro M, Lesti M, Perticucci E, Chakarski IN, Leonardis D, Garini G, Sessa A, Basile C, Alpa M, Scanziani R, Sorba G, Zoccali C, Remuzzi G; REIN‐2 Study Group. Blood‐pressure control for renoprotection in patients with non‐diabetic chronic renal disease (REIN‐2): multicentre, randomised controlled trial. Lancet. 2005; 365: 939– 946. 15766995
  27. [30]Sarnak MJ, Greene T, Wang X, Beck G, Kusek JW, Collins AJ, Levey AS. The effect of a lower target blood pressure on the progression of kidney disease: long‐term follow‐up of the modification of diet in renal disease study. Ann Intern Med. 2005; 142: 342– 351. 15738453
  28. [31]Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D, Douglas‐Baltimore JG, Gassman J, Glassock R, Hebert L, Jamerson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostand SG; African American Study of Kidney Disease and Hypertension Study Group. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002; 288: 2421– 2431. 12435255
  29. [32]Tonelli M, Isles C, Craven T, Tonkin A, Pfeffer MA, Shepherd J, Sacks FM, Furberg C, Cobbe SM, Simes J, West M, Packard C, Curhan GC. Effect of pravastatin on rate of kidney function loss in people with or at risk for coronary disease. Circulation. 2005; 112: 171– 178. 15998677
  30. [33]Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions, Complications Research Group, Lachin JM, Genuth S, Cleary P, Davis MD, Nathan DM. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med. 2000; 342: 381– 389. 10666428 PMC2630213
  31. [34]Raggi P, Boulay A, Chasan‐Taber S, Amin N, Dillon M, Burke SK, Chertow GM. Cardiac calcification in adult hemodialysis patients. A link between end‐stage renal disease and cardiovascular disease? J Am Coll Cardiol. 2002; 39: 695– 701. 11849871
  32. [37]Thourani VH, Keeling WB, Sarin EL, Guyton RA, Kilgo PD, Dara AB, Puskas JD, Chen EP, Cooper WA, Vega JD, Morris CD, Halkos ME, Lattouf OM. Impact of preoperative renal dysfunction on long‐term survival for patients undergoing aortic valve replacement. Ann Thorac Surg. 2011; 91: 1798– 1806;discussion 1806–1807. 21536247
  33. [38]Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón‐Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Lung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M; ESC Committee for Practice Guidelines (CPG); Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio‐Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio‐Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012; 42: S1– S44. 22922698

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Authors
Samad, Z., Sivak, J. A., Phelan, M., Schulte, P. J., Patel, U., & Velazquez, E. J.
Affiliations
  • Duke University (US)
  • Mayo Clinic (US)
Corresponding author
Samad, Zainab
ORCID
Venue
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-10-11
Volume
6
Issue
10
ISSN
2047-9980 (ISSN-L)
DOI
10.1161/jaha.117.006044
PMC
PMC5721834
OpenAlex
W2762376901
Cited by
128
References
5
Citations by year
2026: 12 · 2025: 20 · 2024: 17 · 2023: 16 · 2022: 16 · 2021: 17 · 2020: 19 · 2019: 9 · 2018: 1 · 2017: 1
FWCI
6.35
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Journal of the American Heart Association (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • DukeSpace (Duke University) (submittedVersion, cc-by-nc-nd)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK096493)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
chronic kidney disease, valvular heart disease, aortic stenosis, mitral regurgitation, survival, mortality, hemodialysis, disease severity
MeSH terms
Adult, Age Factors, Aged, Aged, 80 and over, Aortic Valve, Aortic Valve Stenosis, Echocardiography, Female, Glomerular Filtration Rate, Humans, Kidney, Male, Middle Aged, Mitral Valve, Mitral Valve Insufficiency, North Carolina, Prognosis, Retrospective Studies, Risk Factors, Severity of Illness Index, Sex Factors, Time Factors, Comorbidity, Prevalence, Proportional Hazards Models, Databases, Factual, Renal Insufficiency, Chronic, Kaplan-Meier Estimate

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