Calcificaciones valvulares cardíacas y alteraciones del metabolismo óseo-mineral, a propósito de un caso

Abstract

We present the case of a 44-year-old man under replacement therapy with hemodialysis since 1995 and stable hemodynamic and analytical parameters for more than 11 years. Vascular calcifications followed the expected course for this type of patient. In September 2007, after an episode of clinical hyperthyroidism and secondary atrial fibrillation with rapid ventricular response, warfarin treatment was started. Impairment in bone and mineral metabolism disorders in chronic kidney disease (BMM -CKD) biochemical parameters was also observed, with elevated intact parathyroid hormone (PTHi) and phosphorus levels. Despite treatment intensification, these parameters were not adequately controlled for more than 1 year. During this period, vascular calcifications rapidly progressed, with severe consequences to the aortic valve, leading to surgical valvular substitution. Other factors were probably involved in the poor and torpid clinical course of this patient, such as a poor control of BMM-CKD parameters and warfarin treatment. These factors may have been intensified by hemodynamic alterations.