CALCIFICATION OF THE AORTIC VALVE IN PATIENTS ON PROGRAM HEMODIALYSIS
https://doi.org/10.24884/1561-6274-2018-22-4-90-95
Abstract
THE AIM: to determine the relationship between non-traditional risk factors and calcification of the aortic valve in patients with CKD C5D.
PATIENTS AND METHODS. We examined 103 patients receiving treatment with program hemodialysis (53 men and 50 women, mean age 54.8 ± 15.2 years). A traditional nephrological examination was carried out, including the determination of synchronous 24-hour ECG and AD monitoring, an echocardiographic study evaluating the thickness of the carotid arteries intima-media complex. In 79 patients, the status of vitamin D was determined by the enzyme immunoassay.
RESULTS. Traditional (age over 50, male and dyslipidemic) and non- traditional (duration of hemodialysis more than 5 years, calcitriol level less than 10 pmol/L) risk factors for the calcification of the aortic valve were revealed. The average concentration of calcifediol in serum was 33.3 ± 13.8 nmol /L, calcitriol – 11.5 ± 6.9 pmol /L. Calcification of the aortic valve was detected in 48 patients, 2 times more often in men. Stenosis of the aortic valve was found in 28% of men and 22% of women. During the first five years of HD, the prevalence of aortic valve calcification increased 1,5 times and continued to increase later, however, not to the degree of stenosis. The risk of stenosis increased by age over 50 years (3,6 times), whereas the use of alfacalcidol was accompanied by a 70% decrease of stenosis risk. Deficiency of calcitriol (but not calcifediol) increased the risk of calcification (but not stenosis) of the aortic valve in 2 times.
CONCLUSION. Vitamin D deficiency is associated with an increased risk of developing extraosteal calcification, including aortic valve. A decrease in the concentration of calcitriol in the blood serum is a predictor for a specific lesion of the aortic valve. Adequate correction of phosphoric calcium exchange can serve as one of the methods for its prevention.
About the Authors
A. Sh. Rumyantcev
Saint Petersburg State University
Russian Federation
Russian Federation
Russia, 199106, Saint Petersburg, V.O., 21 line 8a
Prof. Alexandr Sh. Rumyantsev MD, PhD, DMedSci., Department of propedeutic of internal diseases. Phone: +7(911) 2677413
H. Rafrafi
Saint Petersburg State University
First Pavlov Saint-Petersburg State Medical University
Russian Federation
Russian Federation
197022, Russia, Saint-Petersburg, Str. Leo Tolstoy, 17 build 54
Rafrafi Hussem MD, graduate student, Department of Propedeutics of Internal Diseases. Phone: +78123380165
O. V. Galkina
First Pavlov Saint Petersburg State Medical University
Russian Federation
Russian Federation
197022, Russia, St-Petersburg, L. Tolstoy st., 17, build. 54
Olga V. Galkina, MD, PhD., head of laboratory of biochemical homeostasis of the Scientific Research Institute of Nephrology. Phone +79213855286
References
1. Coffey S, Cox B, Williams MJ. The prevalence, incidence, progression, and risks of aortic valve sclerosis: a systematic review and meta-analysis. J Am Coll Cardiol 2014;63(25 Pt A):2852-2861. doi: 10.1016/j.jacc.2014.04.018
2. Ahmad Y, Bellamy MF, Baker CSR. Aortic Stenosis in Dialysis Patients. стадии Semin Dial 2017;30(3):224-231. doi: 10.1111/sdi.12582
3. Волгина Г, Селезнев Д, Балкарова О3, Ловчинский Е. Внекостная кальцификация у пациентов с хронической болезнью почек. Врач 2012; (7): 2-8 [Volgina G, Seleznev D, Balkarova OZ, Lovchinskiy E. Extraosteal calcification in patients with chronic kidney disease. Vrach 2012; (7): 2-8 (In Russ.)]
4. Sprague SM, Coyne D. Control of secondary hyperparathyroidism by vitamin D receptor agonists in chronic kidney disease. Clin J Am Soc Nephrol 2010;5(3):512-518. doi: 10.2215/CJN.03850609
5. Levin A, Bakris GL, Molitch M et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007;71(1):31-38
6. Thaden JJ, Nkomo VT, Enriquez-Sarano M. The global burden of aortic stenosis. Prog Cardiovasc Dis 2014 May-Jun; 56(6):565-571. doi: 10.1016/j.pcad.2014.02.006
7. Клинические рекомендации по ведению, диагностике и лечению клапанных пороков сердца. Изд-во НЦССХ им. А.Н. Бакулева РАМН, М., 2009: 356 с [Clinical guidelines for the management, diagnosis and treatment of valvular heart disease. Izd-vo NTCSSKH im. A. N. Bakuleva RAMN, M., 2009: 356 (In Russ.)]
8. Shames S, Gillam LD. Sex differences in aortic valve calcification. Circ Cardiovasc Imaging 6: 8–10, 2013. doi:10.1161/CIRCIMAGING.112.983288
9. Aggarwal SR, Clavel MA, Messika-Zeitoun D et al. Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis. Circ Cardiovasc Imaging 2013; 6: 40–47. doi:10. 1161/CIRCIMAGING.112.980052
10. Рафрафи Х, Волков ММ, Смирнов АВ, Галкина ОВ. Статус витамина D и патология сердечно-сосудистой системы у пациентов с различными стадиями хронической болезни почек. Нефрология 2012; 16 (3): 80-87 [Rafrafi H, Volkov MM, Smirnov AV, Galkina O.V. The status of vitamin D and disorders of the cardiovascular system in patients with different stages of chronic kidney disease. Nephrology (Saint-Petersburg). 2015;19(4):51- 54. (In Russ.)]
11. Рафрафи Х, Румянцев АШ. Статус витамина D и состояние сердечно-сосудистой системы у пациентов с хронической болезнью почек С5д стадии. Нефрология 2015;19(4):51-54 [Rafrafi H, Rumyantsev AS. Vitamin D state and cardiovascular system in patients with chronic kidney disease S5d stage. Nephrology (Saint-Petersburg). 2015;19(4):51-54. (In Russ.)]
Review
For citations:
Rumyantcev A.Sh., Rafrafi H., Galkina O.V. CALCIFICATION OF THE AORTIC VALVE IN PATIENTS ON PROGRAM HEMODIALYSIS. Nephrology (Saint-Petersburg). 2018;22(4):90-95. (In Russ.) https://doi.org/10.24884/1561-6274-2018-22-4-90-95
Views:
1681
Email this article 