Cardiac valve calcification in patients on maintenance dialysis. The role of malnutrition-inflammation syndrome, adiposity andcomponents of sarcopenia. A cross-sectional study

Abstract

Cardiac valve calcification (CVC) is a predictor of cardiovascular disease and all-cause mortality in end stage kidney disease (ESKD) patients. Several risk factors are related to CVC in patients with ESKD including traditional ones as well as inflammation, bone mineral disease and malnutrition. Adiposity is associated with dyslipidemia and proinflammatory activity which could predispose for CVC. Sarcopenia or dynapenia is a state common in patients with ESKD. This study aimed to investigate the relationship of adiposity, sarcopenia and malnutrition-inflammation markers with CVC in patients on maintenance hemodialysis. CVC in aortic (AVC), mitral valves (MVC) and systolic and diastolic dysfunction (DD) were assessed by using two-dimensional echocardiography. Nutritional, adiposity and anthropometric assessments were made using several indices respectively. Creatinine index and muscle strength measurements were also performed. Biochemical parameters such as total proteins, albumin, calcium, phosphate, plasma lipoproteins, C-Reactive Protein and parathyroid hormone were also measured. Adiposity, nutritional, and sarcopenia parameters did not show any difference between patients with or without CVC. Age ≥ 65 years [PR: 1.47 p=0.012], DD [PR: 2.31, p=0.005], high CRP/albumin ratio [PR: 1.46, p=0.01], mid arm circumference (MAC)<26cm [PR: 1.37, p=0.03] were associated with increased prevalence of AVC, while DD [PR: 1.97 p=0.02], high CRP/albumin ratio [PR: 1.56, p=0.02], and MAC < 26cm [PR: 1.52, p=0.01], showed positive correlation with MVC. Age ≥ 65 years [PR: 1.33, p=0.028], DD [PR: 1.72, p=0.01], high CRP/albumin ratio [PR: 1.53, p=0.003], and MAC < 26cm [PR: 1.4, p=0.006], related to greater prevalence of calcification at any valve. Ageing, diastolic dysfunction, MAC and increased CRP/albumin ratio were powerful predictors of CVC in patients on hemodialysis.