Candellier Alexandre, Hénaut Lucie, Morelle Johann, Choukroun Gabriel, Jadoul Michel, Brazier Michel, Goffin Éric
Division of Nephrology, 36673Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France.
UR UPJV 7517, MP3CV, CURS, Amiens, France.
Perit Dial Int. 2021 Mar;41(2):158-167. doi: 10.1177/0896860820941371. Epub 2020 Jul 20.
Aortic stenosis (AS) is the most common valvular disease. It is twice as prevalent in patients with kidney failure as compared to the general population. In addition, AS progresses at a faster rate and is associated with a higher risk of death and poorer quality of life in patients on dialysis. Chronic kidney disease-mineral and bone disorder (CKD-MBD), inflammation, and hemodynamic disturbances contribute to the pathophysiology and progression of AS. Whether the type of dialysis modality, that is, hemodialysis (HD) versus peritoneal dialysis (PD), has a differential impact on the development and progression of AS in patients with kidney failure remains debated. Recent data indicate that the prevalence of valvular calcifications might be lower and the development of AS delayed in PD patients, as compared to those treated with HD. This could be accounted for by several mechanisms including reduced valvular shear stress, better preservation of residual kidney function (with better removal of protein-bound uremic toxins and CKD-MBD profile), and lower levels of systemic inflammation. Given the high morbidity and mortality rates related to interventional procedures in the population with kidney failure, surgical and transcatheter aortic valve replacement should be considered in selected patients with severe AS. Strategies slowing down the progression of aortic valve remodeling should remain the cornerstone in the management of individuals with kidney failure and mild to moderate AS. This review explores the potential benefits of PD in patients with kidney failure and AS and provides some clues to help clinicians in the decision-making process when options for kidney replacement therapy are considered in patients with AS.
主动脉瓣狭窄（AS）是最常见的瓣膜疾病。与普通人群相比，其在肾衰竭患者中的患病率是普通人群的两倍。此外，AS进展速度更快，与透析患者的死亡风险更高和生活质量较差相关。慢性肾脏病 - 矿物质和骨异常（CKD - MBD）、炎症和血流动力学紊乱促成了AS的病理生理学和进展。透析方式，即血液透析（HD）与腹膜透析（PD），对肾衰竭患者AS的发生和进展是否有不同影响仍存在争议。最近的数据表明，与接受HD治疗的患者相比，PD患者瓣膜钙化的患病率可能更低，AS的发生延迟。这可能由多种机制解释，包括瓣膜剪切应力降低、残余肾功能的更好保留（更好地清除与蛋白结合的尿毒症毒素和CKD - MBD特征）以及全身炎症水平较低。鉴于肾衰竭人群介入手术相关的高发病率和死亡率，对于选定的重度AS患者应考虑手术和经导管主动脉瓣置换。减缓主动脉瓣重塑进展的策略应仍然是肾衰竭和轻度至中度AS患者管理的基石。本综述探讨了PD对肾衰竭合并AS患者的潜在益处，并为临床医生在考虑AS患者的肾脏替代治疗选择时的决策过程提供了一些线索。
