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Valvular heart disease in patients with end-stage renal disease

Authors
Rochelle Cunningham, MD
Mary Corretti, MD, FACC
William L Henrich, MD, MACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Valvular heart disease is common in patients undergoing maintenance dialysis. Abnormalities include valvular and annular thickening and calcification of any of the heart valves, but commonly the aortic and mitral valves, with the subsequent development of valvular regurgitation and/or stenosis of the affected valve.

PREDISPOSING FACTORS

Many predisposing factors are associated with the development of valvular disease in dialysis patients, perhaps the most significant being the presence of secondary hyperparathyroidism [1-5]. Valvular calcification is also associated with an elevated calcium-phosphorus product, vascular calcification, hypercalcemia, and hyperphosphatemia, all findings that can occur in patients with marked secondary hyperparathyroidism. (See "Indications for parathyroidectomy in end-stage renal disease".)

Valvular calcification may also be found in patients without secondary hyperparathyroidism, particularly among those with adynamic bone disease, older patients, and those who have undergone dialysis for a longer duration [6,7]. The association with adynamic bone disease may be related to the use of calcitriol and calcium-containing phosphate binders, with increased calcium deposition [8]. Progressive disease may be attenuated in part by substituting sevelamer for calcium-containing phosphate binders, as shown in a trial of 200 hemodialysis patients followed over a one-year period [9].

Additional factors that may enhance the development of valvular heart disease in this patient population include the presence of one or more of the following conditions [10]:

Hypertension

                             

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Literature review current through: Nov 2016. | This topic last updated: Wed Sep 30 00:00:00 GMT+00:00 2015.
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