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

Łukasz Kuźma, Jolanta Małyszko, Hanna Bachórzewska-Gajewska, Marta Maria Niwińska, Anna Kurasz, Małgorzata Zalewska-Adamiec, Marcin Kożuch, Sławomir Dobrzycki, Łukasz Kuźma, Jolanta Małyszko, Hanna Bachórzewska-Gajewska, Marta Maria Niwińska, Anna Kurasz, Małgorzata Zalewska-Adamiec, Marcin Kożuch, Sławomir Dobrzycki

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 < 0.001), creatinine (OR:1.27, 95% CI: 1.12-1.43, p < 0.001), CKD (OR: 1.30, 95% CI: 1.17-1.44, p < 0.001), reduced ejection fraction (EF) (OR: 0.98, 95% CI: 0.97-0.99, p = 0.01) and coexisting of AVS (OR: 1.19, 95% CI: 1.04-1.35, p = 0.01).

Conclusions: Mitral valve defects more often than aortic valve defects coexist with chronic kidney disease. Regardless of the stage, chronic kidney disease is an additional factor affecting the prognosis in patients with heart defects. Factors increasing the risk of death were age, creatinine concentration and reduced EF. The monitoring of renal function in patients with VHD should be crucial as well as the implementation of treatment at an early stage.

Keywords: Aortic stenosis; Chronic kidney disease; Glomerular filtration rate; Mitral insufficiency; Valvular heart disease.

Conflict of interest statement

The authors declare that they do not have any conflict of interest.

Figures

Fig. 1
Fig. 1
Chronic kidney disease among patients with valvular heart defect
Fig. 2
Fig. 2
The percentage of deaths depending to the eGFR (Kruskal–Wallis test p < 0.001; multiple comparisons using the Steel–Dwass–Critchlow–Fligner p  < 0.001 for all groups)

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