The Prevalence of Valvular and Vascular Calcifications in Prevalent Hemodialysis Patients

Abstract

Background: Patients with chronic kidney disease (CKD) are likely to get valve calcification 10-20 years earlier than the normal population  secondary to uremia. This condition is typically diagnosed through transthoracic echocardiography. Vascular calcification  resulted in arterial stiffness and an increase in pulse wave velocity (PWV) in large elastic-type arteries. The intima-media complex acts as  a stand-in marker for atherosclerosis and is where lipids are deposited during plaque development.

Objective: This study aimed to  estimate the prevalence of valvular and vascular calcifications in hemodialysis patients at Ain Shams Specialized Hospital, Cairo, Egypt.  

Patients and Methods: A crosssectional pilot study was conducted on 100 prevalent hemodialysis patients who were maintained on  thrice-weekly hemodialysis sessions at Ain Shams Specialized Hospital in the period from January to June 2020. Echocardiography was  performed to assess the presence of valvular calcification; PWV was measured to evaluate vascular stiffness. Intima-media thickness  (IMT) and carotid plaques were detected using an echo-doppler study of the carotid arteries.

Results: The study was conducted on 100  patients undergoing hemodialysis treatment for 6 months. Out of these, 55% of patients were males. Among the studied patients, 15%  had mitral valve (MV) calcification, 61% had aortic valve (AV) calcification, and 17% had carotid plaques. Patients with calcification of the  MV had an aortic PWV mean of 1.587 m/s. 53.33% of these patients had carotid plaques and the IMT mean was 6.567mm higher than the  non-MV calcification group. Patients with aortic AV calcifications had a mean IMT of 5.038 mm and a higher percentage (22.95%) of  carotid plaques compared to the non-aortic calcification group. Patients with carotid plaques had higher levels of aortic wave pulse  velocity (mean 1.54 m/s) and IMT (mean 7.653mm). Also, there was a significant positive correlation between intimal medial thickness  and aortic PWV (p-value= 0.003), and a significant negative correlation between IMT and ejection fraction (p-value=0.048*).

Conclusions:  Valvular calcification is widespread in individuals on hemodialysis, with AV calcification being more common than MV calcification.  Hemodialysis patients with valvular calcifications had a higher incidence of carotid intimal thickness. Aortic wave pulse velocity correlated  with increasing carotid intimal thickness and predicted arterial atherosclerosis.