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Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects.

ABSTRACT: INTRODUCTION:Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy. AIM:Analysis impact of CKD on long-term prognosis in patients with VHD. MATERIAL AND METHODS:The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528?±?1454 days. RESULTS:The average age of the studied population was 66.75 (SD?=?10.34), male gender was dominant 56% (N?=?579). Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CKD occurred in 37.1% (N?=?380) patients mostly with mitral stenosis (50%, N?=?16) and those with severe MVI (44.8%, N?=?94). During the observational period, 52.7% (N?=?540) deaths were noted. Increased risk of mortality was associated mostly with age (OR: 1.02, 95% CI: 1.00-1.03, p?

SUBMITTER: Kuzma L

PROVIDER: S-EPMC7575476 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects.

Kuźma Łukasz Ł Małyszko Jolanta J Bachórzewska-Gajewska Hanna H Niwińska Marta Maria MM Kurasz Anna A Zalewska-Adamiec Małgorzata M Kożuch Marcin M Dobrzycki Sławomir S

International urology and nephrology 20200714 11

<h4>Introduction</h4>Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy.<h4>Aim</h4>Analysis impact of CKD on long-term prognosis in patients with VHD.<h4>Material and methods</h4>The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ± 1454 days.<h4>Results</h4>The aver ...[more]

PMID: 32661631

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Project description:Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long-term follow-up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32-44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18-26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow-up of 4.5 years, 91 deaths accounted for 4.21 higher-than-expected mortality in the age-matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance-either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six-month changes in the composite clinical score and in the 6-minute walk test distance were related to survival. Conclusions Persistent valvular heart disease-pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.

Project description:Background: In patients with chronic kidney disease (CKD), physical functional limitations and heart failure (HF) are common, and each is associated with adverse outcomes. However, their joint effects on mortality are not clear. Design and Methods: Using administration data from the geriatric department in a tertiary hospital, retrospective longitudinal analyses of patients aged ≥65 years with CKD were consecutively enrolled from February 2010 to November 2015. Baseline CKD stages, HF with reduced and preserved ejection fraction (HFrEF and HFpEF), Rockwood frailty index, handgrip strength (HGS), 6-m walking speed, and timed up-and-go test were used to predict the prevalence of frailty, physical disability, and all-cause mortality. Results: Among 331 old patients with CKD, their mean age was 81.3 ± 6.6 years. CKD stages showed the following distributions: stage 3, 74.9%; stage 4, 15.7%; stage 5, 9.4%. The prevalence of HF was 23.3%, and Rockwood frailty was 74.3%. Rockwood frailty and HF were both significantly associated with CKD stages. After a mean follow-up period of 3.1 ± 2.1 years, 44 patients died, and a crude analysis showed that stage 4, stage 5 CKD, low HGS, and Rockwood frailty index were associated with mortality. Regarding the survival of these patients, the adjusted mortality hazard ratio for CKD stage 5 was 3.84 against stage 3A [95% confidence interval (CI) 1.51-9.75], 1.04 (95% CI 1.01-1.07) for higher Rockwood frailty score, 4.78 (95% CI 1.26-18.11) for HFrEF, and 3.47 (95% CI 1.15-10.42) for low HGS. Survival analysis using Kaplan-Meier survival plots showed that patients with both HF and poor HGS had the poorest survival. Conclusions: Our study shows that both low physical performance and HF were common in old CKD patients and were associated with CKD stages. HF, frailty, and HGS all independently predicted the mortality of these CKD patients. The mortality is especially high amongst individuals with both HF and decreased HGS.

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Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects.

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Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects.

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