Association of cardiac valvular calcifications and C-reactive protein with cardiovascular mortality in incident hemodialysis patients

A Japanese cohort study

Hiroshi Takahashi, Hideki Ishii, Toru Aoyama, Daisuke Kamoi, Hirotake Kasuga, Yasuhiko Ito, Kaoru Yasuda, Miho Tanaka, Daiji Yoshikawa, Shoichi Maruyama, Seiichi Matsuo, Toyoaki Murohara, Yukio Yuzawa

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Cardiac valve calcification is seen frequently in patients undergoing dialysis. Serum C-reactive protein (CRP) level also is reported to predict future cardiovascular events. We investigated the association among valve calcification, CRP level, and mortality in patients with end-stage renal disease who were just beginning hemodialysis (HD) therapy. Study Design: Observational cohort. Setting & Participants: 1,290 consecutive patients who just started HD therapy were enrolled and were followed up to 10 years. Predictor: Patients were divided into 3 groups according to number of calcified valves: those without valve calcification, those with calcification in a single (aortic or mitral) valve, and those with calcification in both valves. They also were divided into tertiles according to CRP level. Outcomes: Cardiovascular and all-cause mortality. Measurements: Echocardiography and CRP measurement were performed within 1 month after beginning HD therapy. Results: During follow-up (median, 51 months), 335 (25.9%) patients died, including 156 (12.1%) of cardiovascular disease. The adjusted HR for cardiovascular mortality was 2.80 (95% CI, 1.63-4.81) for 2 calcifications versus 0 (P < 0.001). Furthermore, the risk of cardiovascular mortality was 3.66-fold higher in patients with calcifications in both valves (highest tertile of CRP) compared with patients without valve calcification (lowest tertile of CRP; P < 0.001). Limitations: Precise medical treatments or therapeutic interventions were not evaluated. Conclusions: Valve calcification and elevated CRP levels were not only related to additively increased risk of mortality, but also improved the prediction of mortality in patients with end-stage renal disease who had just begun HD therapy.

Original languageEnglish
Pages (from-to)254-261
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume61
Issue number2
DOIs
Publication statusPublished - 01-02-2013

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C-Reactive Protein
Renal Dialysis
Cohort Studies
Mortality
Chronic Kidney Failure
Therapeutics
Heart Valves
Mitral Valve
Observational Studies
Echocardiography
Blood Proteins
Dialysis
Cardiovascular Diseases

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Takahashi, Hiroshi ; Ishii, Hideki ; Aoyama, Toru ; Kamoi, Daisuke ; Kasuga, Hirotake ; Ito, Yasuhiko ; Yasuda, Kaoru ; Tanaka, Miho ; Yoshikawa, Daiji ; Maruyama, Shoichi ; Matsuo, Seiichi ; Murohara, Toyoaki ; Yuzawa, Yukio. / Association of cardiac valvular calcifications and C-reactive protein with cardiovascular mortality in incident hemodialysis patients : A Japanese cohort study. In: American Journal of Kidney Diseases. 2013 ; Vol. 61, No. 2. pp. 254-261.
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abstract = "Background: Cardiac valve calcification is seen frequently in patients undergoing dialysis. Serum C-reactive protein (CRP) level also is reported to predict future cardiovascular events. We investigated the association among valve calcification, CRP level, and mortality in patients with end-stage renal disease who were just beginning hemodialysis (HD) therapy. Study Design: Observational cohort. Setting & Participants: 1,290 consecutive patients who just started HD therapy were enrolled and were followed up to 10 years. Predictor: Patients were divided into 3 groups according to number of calcified valves: those without valve calcification, those with calcification in a single (aortic or mitral) valve, and those with calcification in both valves. They also were divided into tertiles according to CRP level. Outcomes: Cardiovascular and all-cause mortality. Measurements: Echocardiography and CRP measurement were performed within 1 month after beginning HD therapy. Results: During follow-up (median, 51 months), 335 (25.9{\%}) patients died, including 156 (12.1{\%}) of cardiovascular disease. The adjusted HR for cardiovascular mortality was 2.80 (95{\%} CI, 1.63-4.81) for 2 calcifications versus 0 (P < 0.001). Furthermore, the risk of cardiovascular mortality was 3.66-fold higher in patients with calcifications in both valves (highest tertile of CRP) compared with patients without valve calcification (lowest tertile of CRP; P < 0.001). Limitations: Precise medical treatments or therapeutic interventions were not evaluated. Conclusions: Valve calcification and elevated CRP levels were not only related to additively increased risk of mortality, but also improved the prediction of mortality in patients with end-stage renal disease who had just begun HD therapy.",
author = "Hiroshi Takahashi and Hideki Ishii and Toru Aoyama and Daisuke Kamoi and Hirotake Kasuga and Yasuhiko Ito and Kaoru Yasuda and Miho Tanaka and Daiji Yoshikawa and Shoichi Maruyama and Seiichi Matsuo and Toyoaki Murohara and Yukio Yuzawa",
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Takahashi, H, Ishii, H, Aoyama, T, Kamoi, D, Kasuga, H, Ito, Y, Yasuda, K, Tanaka, M, Yoshikawa, D, Maruyama, S, Matsuo, S, Murohara, T & Yuzawa, Y 2013, 'Association of cardiac valvular calcifications and C-reactive protein with cardiovascular mortality in incident hemodialysis patients: A Japanese cohort study', American Journal of Kidney Diseases, vol. 61, no. 2, pp. 254-261. https://doi.org/10.1053/j.ajkd.2012.09.007

Association of cardiac valvular calcifications and C-reactive protein with cardiovascular mortality in incident hemodialysis patients : A Japanese cohort study. / Takahashi, Hiroshi; Ishii, Hideki; Aoyama, Toru; Kamoi, Daisuke; Kasuga, Hirotake; Ito, Yasuhiko; Yasuda, Kaoru; Tanaka, Miho; Yoshikawa, Daiji; Maruyama, Shoichi; Matsuo, Seiichi; Murohara, Toyoaki; Yuzawa, Yukio.

In: American Journal of Kidney Diseases, Vol. 61, No. 2, 01.02.2013, p. 254-261.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of cardiac valvular calcifications and C-reactive protein with cardiovascular mortality in incident hemodialysis patients

T2 - A Japanese cohort study

AU - Takahashi, Hiroshi

AU - Ishii, Hideki

AU - Aoyama, Toru

AU - Kamoi, Daisuke

AU - Kasuga, Hirotake

AU - Ito, Yasuhiko

AU - Yasuda, Kaoru

AU - Tanaka, Miho

AU - Yoshikawa, Daiji

AU - Maruyama, Shoichi

AU - Matsuo, Seiichi

AU - Murohara, Toyoaki

AU - Yuzawa, Yukio

PY - 2013/2/1

Y1 - 2013/2/1

N2 - Background: Cardiac valve calcification is seen frequently in patients undergoing dialysis. Serum C-reactive protein (CRP) level also is reported to predict future cardiovascular events. We investigated the association among valve calcification, CRP level, and mortality in patients with end-stage renal disease who were just beginning hemodialysis (HD) therapy. Study Design: Observational cohort. Setting & Participants: 1,290 consecutive patients who just started HD therapy were enrolled and were followed up to 10 years. Predictor: Patients were divided into 3 groups according to number of calcified valves: those without valve calcification, those with calcification in a single (aortic or mitral) valve, and those with calcification in both valves. They also were divided into tertiles according to CRP level. Outcomes: Cardiovascular and all-cause mortality. Measurements: Echocardiography and CRP measurement were performed within 1 month after beginning HD therapy. Results: During follow-up (median, 51 months), 335 (25.9%) patients died, including 156 (12.1%) of cardiovascular disease. The adjusted HR for cardiovascular mortality was 2.80 (95% CI, 1.63-4.81) for 2 calcifications versus 0 (P < 0.001). Furthermore, the risk of cardiovascular mortality was 3.66-fold higher in patients with calcifications in both valves (highest tertile of CRP) compared with patients without valve calcification (lowest tertile of CRP; P < 0.001). Limitations: Precise medical treatments or therapeutic interventions were not evaluated. Conclusions: Valve calcification and elevated CRP levels were not only related to additively increased risk of mortality, but also improved the prediction of mortality in patients with end-stage renal disease who had just begun HD therapy.

AB - Background: Cardiac valve calcification is seen frequently in patients undergoing dialysis. Serum C-reactive protein (CRP) level also is reported to predict future cardiovascular events. We investigated the association among valve calcification, CRP level, and mortality in patients with end-stage renal disease who were just beginning hemodialysis (HD) therapy. Study Design: Observational cohort. Setting & Participants: 1,290 consecutive patients who just started HD therapy were enrolled and were followed up to 10 years. Predictor: Patients were divided into 3 groups according to number of calcified valves: those without valve calcification, those with calcification in a single (aortic or mitral) valve, and those with calcification in both valves. They also were divided into tertiles according to CRP level. Outcomes: Cardiovascular and all-cause mortality. Measurements: Echocardiography and CRP measurement were performed within 1 month after beginning HD therapy. Results: During follow-up (median, 51 months), 335 (25.9%) patients died, including 156 (12.1%) of cardiovascular disease. The adjusted HR for cardiovascular mortality was 2.80 (95% CI, 1.63-4.81) for 2 calcifications versus 0 (P < 0.001). Furthermore, the risk of cardiovascular mortality was 3.66-fold higher in patients with calcifications in both valves (highest tertile of CRP) compared with patients without valve calcification (lowest tertile of CRP; P < 0.001). Limitations: Precise medical treatments or therapeutic interventions were not evaluated. Conclusions: Valve calcification and elevated CRP levels were not only related to additively increased risk of mortality, but also improved the prediction of mortality in patients with end-stage renal disease who had just begun HD therapy.

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U2 - 10.1053/j.ajkd.2012.09.007

DO - 10.1053/j.ajkd.2012.09.007

M3 - Article

VL - 61

SP - 254

EP - 261

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 2

ER -