All-cause and cardiovascular mortality in patients undergoing hemodialysis with aortic sclerosis and mild-to-moderate aortic stenosis: A cohort study. (August 2021)

• Record Type: Journal Article
• Authors: Kurasawa, Shimon; Hishida, Manabu; Imaizumi, Takahiro; Okazaki, Masaki; Nishibori, Nobuhiro; Kondo, Toru; Kasuga, Hirotake; Maruyama, Shoichi
• Is Part Of: Atherosclerosis. Volume 331(2021)
• Page Start: 12
• Page End: 19
• Publication Date: 2021-08
• Subjects: Aortic stenosis -- Aortic sclerosis -- Calcific aortic valve disease -- Aortic valve calcification -- All-cause death -- Cardiovascular death -- Hemodialysis; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2021.06.910
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Mild-to-moderate aortic stenosis (AS) and aortic sclerosis, a precursor of AS, are associated with mortality in the general population; however, their association in patients undergoing hemodialysis with higher morbidity of AS is unknown. Thus, we investigated the mortality of aortic sclerosis and mild-to-moderate AS in patients undergoing hemodialysis. Methods: This was a retrospective multicenter cohort study of consecutive patients undergoing hemodialysis at nine dialysis facilities who underwent screening echocardiography between January 2008 and December 2019. We investigated the mortality of patients with aortic sclerosis or mild-to-moderate AS using multivariable Cox proportional hazards regression. Results: Among 1, 878 patients undergoing hemodialysis, those with normal aortic valves, aortic sclerosis, mild AS, moderate AS, severe AS, and prosthetic aortic valves were 844 (45%), 793 (42%), 161 (8.6%), 38 (2.0%), 11 (0.6%), and 31 (1.7%), respectively. After excluding patients with severe AS and prosthetic aortic valves, we performed comparative analysis on 1, 836 patients (mean age, 67 years; 66% male). In a median follow-up of 3.6 years, crude death rates (per 100 person-years) were 5.2, 10.6, and 13.0 in patients with normal aortic valves, aortic sclerosis, and mild-to-moderate AS, respectively. Compared with normal aortic valves, both aortic sclerosis and mild-to-moderate AS were associated with all-cause and cardiovascular death: adjusted hazard ratios (95% confidence intervals) were 1.36 (1.13–1.65) and 1.36 (1.02–1.80) for all-cause death; and 1.52 (1.06–2.17) and 1.74 (1.04–2.92) for cardiovascular death, respectively. Conclusions: Aortic sclerosis and mild-to-moderate AS were independent risk factors for all-cause and cardiovascular death in patients undergoing hemodialysis. Graphical abstract: Image 1 Highlights: More than half of hemodialysis patients had calcific aortic valve disease (CAVD). Approximately 10% of the patients had aortic stenosis (AS). Aortic sclerosis and mild-to-moderate AS were independent mortality risk factors. Some factors associated with CAVD differed between development and progression.