Kitamura Mineaki, Yamashita Hiroshi, Sawase Atsushi, Takeno Masayoshi, Maemura Koji, Mukae Hiroshi, Nishino Tomoya
Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan.
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Clin Exp Nephrol. 2025 Jan;29(1):91-98. doi: 10.1007/s10157-024-02548-w. Epub 2024 Aug 22.
Aortic stenosis (AS) and aortic valve calcification (AVC) are occasionally observed in patients receiving maintenance dialysis. However, their prevalence and factors associated with them in patients undergoing dialysis remain unknown. We aimed to elucidate the aortic valve status at the time of dialysis initiation and patient prognosis based on aortic valve status.
We analyzed 289 patients initiating dialysis (hemodialysis: peritoneal dialysis = 275:14) between 2016 and 2023. "AS and/or AVC" was detected using echocardiography. AS was defined as a maximum transaortic velocity > 2.0 m/s. Statistical analyses including multivariable logistic regression and Cox regression were used to assess the association between patient characteristics and survival outcomes.
Aortic valve changes were observed in 121 (42%) patients, among which 33 (11%) met the AS criteria. The mean age of patients in the AS, AVC without AS, and control groups was 79.1 ± 8.9, 75.9 ± 9.2, and 68.3 ± 12.9, respectively (P < 0.001). Multivariable logistic regression models showed that only age was associated with aortic valve changes (P < 0.001). Age and other important factor-adjusted multivariable Cox regression models showed that AS was an independent risk factor for death after dialysis initiation (hazard ratio (HR): 1.95, 95% confidence interval (CI): 1.06 - 3.59, P = 0.04). However, aortic valve changes ("AS and/or AVC") were not a risk factor for death (HR: 1.51, 95% CI 0.95 - 2.39, P = 0.08).
With the growing older population undergoing dialysis, aortic valve changes should be closely monitored. Particularly, AS is crucial because of its impact on patient prognosis.
在接受维持性透析的患者中偶尔会观察到主动脉瓣狭窄（AS）和主动脉瓣钙化（AVC）。然而，它们在透析患者中的患病率以及与之相关的因素仍不清楚。我们旨在阐明透析开始时的主动脉瓣状态以及基于主动脉瓣状态的患者预后。
我们分析了2016年至2023年间开始透析的289例患者（血液透析：腹膜透析 = 275：14）。使用超声心动图检测“AS和/或AVC”。AS定义为最大跨主动脉速度>2.0 m/s。采用包括多变量逻辑回归和Cox回归在内的统计分析来评估患者特征与生存结局之间的关联。
121例（42%）患者观察到主动脉瓣改变，其中33例（11%）符合AS标准。AS组、无AS的AVC组和对照组患者的平均年龄分别为79.1±8.9岁、75.9±9.2岁和68.3±12.9岁（P<0.001）。多变量逻辑回归模型显示，只有年龄与主动脉瓣改变相关（P<0.001）。年龄和其他重要因素调整后的多变量Cox回归模型显示，AS是透析开始后死亡的独立危险因素（风险比（HR）：1.95，95%置信区间（CI）：1.06 - 3.59，P = 0.04）。然而，主动脉瓣改变（“AS和/或AVC”）不是死亡的危险因素（HR：1.51，95%CI 0.95 - 2.39，P = 0.08）。
随着透析老年人口的增加，应密切监测主动脉瓣改变。特别是，AS因其对患者预后的影响而至关重要。
