Association of aortic valve calcification with carotid artery lesions and peripheral artery disease in patients with chronic kidney disease: a cross-sectional study

Yui Arita,Kimika Arakawa,Takanari Kitazono,Masaru Nakayama,Susumu Tsuda,Rina Imazu,Yuta Matsukuma,Ryota Yoshitomi,Mitsuhiro Tominaga,Akiko Fukui,Toshiaki Nakano,Yuri Sonoda,Makiko Seki,Kazuhiko Tsuruya

doi:10.1186/s12882-020-01864-z

Abstract

BackgroundPatients with chronic kidney disease (CKD) reportedly have a high prevalence of aortic valve calcification (AVC). In population-based studies, AVC is considered a manifestation of systemic atherosclerosis. The association of AVC with atherosclerotic lesions has not been fully investigated in predialysis patients. The present study was performed to determine whether carotid artery lesions and peripheral artery disease (PAD) are associated with AVC in patients with CKD not on dialysis.MethodsIn total, 749 patients were included in this cross-sectional study. AVC was evaluated using echocardiography. Carotid artery lesions including carotid artery plaque (CAP) and PAD were simultaneously examined in each patient. A logistic regression analysis was applied to determine the factors associated with AVC.ResultsAVC, CAP, and PAD were found in 201, 583, and 123 patients, respectively. In the multivariable analyses adjusted for covariates including the estimated glomerular filtration rate and makers of mineral metabolism (serum calcium, serum phosphorus, parathyroid hormone, 1,25-dihydroxyvitamin D, and fibroblast growth factor 23), AVC was significantly associated with the presence of CAP [odds ratio (OR), 3.37; 95% confidence interval (CI), 1.43–7.95], the presence of PAD (OR, 1.76; 95% CI, 1.10–2.81), the CAP score (per 1.0-point increase) (OR, 1.06; 95% CI, 1.02–1.11), and the ankle-brachial blood pressure index (per 0.1-point increase) (OR, 0.83; 95% CI, 0.72–0.95).ConclusionsAVC was associated with atherosclerotic lesions independent of kidney function and mineral metabolism. We consider that this association between AVC and atherosclerosis might reflect the burden of shared atherosclerotic risk factors.

Highlights

Patients with chronic kidney disease (CKD) reportedly have a high prevalence of aortic valve calcification (AVC)
With regard to the association of AVC with mineral metabolism, a lower 1, 25(OH)2D level and a higher fibroblast growth factor 23 (FGF23) level were related to AVC
AVC was significantly associated with the presence of carotid artery plaque (CAP) and peripheral artery disease (PAD), a higher CAP score, and a lower ankle-brachial blood pressure index (ABPI)

Summary

Introduction

Patients with chronic kidney disease (CKD) reportedly have a high prevalence of aortic valve calcification (AVC). Patients with chronic kidney disease (CKD) are considered to have a high risk of cardiovascular (CV) morbidity and mortality [1]. A previous study showed that leftsided valve disease such as aortic stenosis and mitral regurgitation was highly prevalent and related to higher mortality in patients with CKD [2]. Research has demonstrated that moderate/severe aortic valve calcification (AVC) is associated with CV events and mortality in patients with aortic stenosis [5, 6] and in the general population [7, 8]. In dialysis [9] or predialysis [10] patients, univariable analysis showed a significant association of AVC with all-cause mortality; multivariable analysis did not

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