PP.25.12

Abstract

Objective: Chronic kidney disease (CKD) is associated with the presence and progression of vascular and cardiac valve calcification. Vascular calcification may promote the reversal of arterial stiffness mismatch. The aim of the study was to evaluate the relationship between cardiac valve calcification and aortic-brachial arterial stiffness mismatch in pre-dialysis hypertensive CKD patients. Design and method: The study included 112 adult treated hypertensive CKD patients: 54 - with CKD IIIa (age 59,5 ± 8,4 years, male 46,3%, BP 149,6 ± 10,3/85,8 ± 9,8 mmHg), 35 - with CKD IIIb (age 60,2 ± 7,8 years, male 45,7%, BP 152,5 ± 12,5/86,4 ± 10,2 mmHg) and 23 with CKD IV (age 57,3 ± 10,2, male 43,4%, BP 156,1 ± 14,3/92,8 ± 12,4 mmHg). The aortic-brachial arterial stiffness mismatch (pulse wave velocity (PWV ratio) were assessed using carotid-femoral PWV divided by carotid-radial PWV. On 2D echocardiography mitral valve calcification was graded according to the Wilkins score index, aortic valve calcification scoring was done empirically (1 - partial calcification on single cusp; 2 - partial calcification on 2 cusps; 3 - extended calcification on 2 cusps; 4 - extended calcification on all 3 cusps). P < 0,05 was considered significant for group comparisons, Spearman correlation test and multivariate regression analysis. Results: In CKD IIIa, IIIb and IV mitral valve calcification score of grade 1 was observed in 41% 28% and 22%, respectively, of grade 2 - in 50%, 60% and 65%, respectively, of grade 3 - 0, 6% and 13%, respectively. Aortic valve calcification score 1 was found in 6%, 3% and 0, respectively, score 2 - 44%, 31% and 9, respectively, score 3 - in 50%, 60% and 65%, respectively, score 4 - 0, 6% and 26%, respectively. Average cardiac valve calcification score in CKD IIIa was 2,6 + 0,2, in CKD IIIb 2,8 + 0,3,in CKD IV - 3,6 + 0,2 (p < 0,05 vs CKD IIIa). PWV ratio In CKD IIIa was 0,82 ± 0,25, CKD IIIb - 0,90 ± 0,27, in CKD IV 1,09 ± 0,33 (p < 0,05 vs CKD IIIa). For the whole study population (n = 112) multivariate analysis revealed independent significant correlation between cardiac valve calcification score and PWV ratio β=0,38 (p < 0,05). Conclusions: In the pre-dialysis hypertensive CKD patients cardiac valve calcification score associated with loss of arterial stiffness mismatch.