Abstract
Cardiac valve calcification is highly prevalent in patients with chronic kidney disease (CKD). Low vitamin D levels are associated with vascular calcification in CKD. However, the association between vitamin D levels and cardiac valve calcification is unknown. A total of 513 patients with pre-dialysis CKD were included in this cross-sectional study. Aortic valve calcification (AVC) and mitral valve calcification (MVC) were assessed using two-dimensional echocardiography. The associations between AVC and MVC and baseline variables were investigated using logistic regression analyses. In multivariable analysis, serum 1,25(OH)2D level was independently associated with AVC (odds ratio [OR], 0.87; P < 0.001) and MVC (OR, 0.92; P < 0.001). Additionally, age, diabetes, coronary heart disease, calcium × phosphate product, and intact parathyroid hormone levels were independently associated with AVC and MVC. Systolic blood pressure was independently associated with AVC. A receiver-operating characteristic (ROC) curve analysis showed that the best cutoff values of serum 1,25(OH)2D levels for predicting AVC and MVC were ≤ 12.5 and ≤ 11.9 pg/dl, respectively. Serum 1,25(OH)2D deficiency is independently associated with AVC and MVC in patients with CKD, suggesting that serum 1,25(OH)2D level may be a potential biomarker of AVC and MVC in these patients.
Highlights
Cardiac valve calcification is highly prevalent in patients with chronic kidney disease (CKD)
Patients with higher CKD stages were likely to have a higher prevalence of Aortic valve calcification (AVC) (CKD stages 3 vs. 4 vs. 5: 8.5% vs. 25.4% vs. 49.2%, P < 0.001), mitral valve calcification (MVC) (CKD stages 3 vs. 4 vs. 5: 7.7% vs. 19.9% vs. 39.3%, P < 0.001), and at least one valve calcification (CKD stages 3 vs. 4 vs. 5: 12.9% vs. 32.0% vs. 55.7%, P < 0.001) than that seen in patients with lower CKD stages
Research has focused on the pathophysiology and clinical impact of vascular calcification as an important part of CKD-mineral and bone disorder (MBD), with less attention being paid to cardiac valve calcification in patients with CKD19
Summary
Cardiac valve calcification is highly prevalent in patients with chronic kidney disease (CKD). Multiple contributors, including traditional factors (age, hypertension, diabetes, and dyslipidemia) as well as non-traditional factors (hyperphosphatemia, calcium phosphate product, and parathyroid function), have been suggested to be involved in cardiac valve calcification in patients with CKD6. Low levels of 25-hydroxyvitamin D [25(OH)D] or 1,25-dihydroxyvitamin D [1,25(OH)2D] have been reported to be associated with coronary artery and cardiac valve calcification in patients with risk factors for CVD and in the general population[8,9,10]. An independent association between low levels of 25(OH)D and coronary artery calcification has been previously reported in patients with C KD12,13, whether vitamin D deficiency is associated with cardiac valve calcification in patients with CKD is still unknown
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