CALCIFICATION OF THE AORTIC VALVE IN PATIENTS ON PROGRAM HEMODIALYSIS

Abstract

THE AIM: to determine the relationship between non-traditional risk factors and calcification of the aortic valve in patients with CKD C5D.PATIENTS AND METHODS. We examined 103 patients receiving treatment with program hemodialysis (53 men and 50 women, mean age 54.8 ± 15.2 years). A traditional nephrological examination was carried out, including the determination of synchronous 24-hour ECG and AD monitoring, an echocardiographic study evaluating the thickness of the carotid arteries intima-media complex. In 79 patients, the status of vitamin D was determined by the enzyme immunoassay.RESULTS.Traditional (age over 50, male and dyslipidemic) and non- traditional (duration of hemodialysis more than 5 years, calcitriol level less than 10 pmol/L) risk factors for the calcification of the aortic valve were revealed. The average concentration of calcifediol in serum was 33.3 ± 13.8 nmol /L, calcitriol – 11.5 ± 6.9 pmol /L. Calcification of the aortic valve was detected in 48 patients, 2 times more often in men. Stenosis of the aortic valve was found in 28% of men and 22% of women. During the first five years of HD, the prevalence of aortic valve calcification increased 1,5 times and continued to increase later, however, not to the degree of stenosis. The risk of stenosis increased by age over 50 years (3,6 times), whereas the use of alfacalcidol was accompanied by a 70% decrease of stenosis risk. Deficiency of calcitriol (but not calcifediol) increased the risk of calcification (but not stenosis) of the aortic valve in 2 times.CONCLUSION.Vitamin D deficiency is associated with an increased risk of developing extraosteal calcification, including aortic valve. A decrease in the concentration of calcitriol in the blood serum is a predictor for a specific lesion of the aortic valve. Adequate correction of phosphoric calcium exchange can serve as one of the methods for its prevention.