Cardiac Valve Calcification As a Predictor of Cardiovascular Outcomes in Peritoneal Dialysis Patients: an Inverse Probability of Treatment Weighting Analysis

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2022 Dec 1

PMID 36454448

Authors

Jichao Guan

Haiying Xie

Hongya Wang

Shuwen Gong

Xiujuan Wu

Tujian Gong

Shuijuan Shen

Affiliations

Soon will be listed here.

Abstract

Background: Cardiovascular events (CVE) are the leading cause of death in peritoneal dialysis (PD) patients. The predictive value of cardiac valve calcification (CVC) for CVE in dialysis patients remains controversial. In particular, such studies are limited in PD patients. We aimed to examine the predictive role of CVC for CVE and cardiovascular mortality in PD patients.

Methods: A retrospective analysis was performed on patients who initiated PD in our hospital. According to the result of echocardiography, patients were divided into CVC group and non-CVC group. The differences in baseline demographic characteristics, biochemical variables, comorbidities, and clinical outcomes between the two groups were compared. Kaplan-Meier method was used to obtain survival curves. The Cox regression model was used to evaluate the influence of CVC for cardiovascular outcomes. The inverse probability of treatment weighting (IPTW) was used to eliminate influence of the confounders in the groups.

Results: 458 peritoneal dialysis patients were enrolled in this study. 77 patients were in CVC group and 381 patients in non-CVC group. The average follow-up time was (32 ± 21) months. At baseline, the absolute standardized difference (ASD) of age, BMI, history of CVE, diabetes, LVEF, LVMI, albumin, calcium, phosphorus, triglycerides, hsCRP, urine volume, Kt/V, statins and vitamin D intake rate were greater than 0.1 between the two groups. All of ASD dropped to less than 0.1 after IPTW, which meant that the balance had been reached between the two groups. Multivariable logistic analysis showed that advanced age, diabetes, and hyperphosphatemia were associated with CVC. The Kaplan-Meier survival curve showed the cumulative CVE-free survival rate and cardiovascular survival rate of CVC group were significantly lower than that of non-CVC group before and after IPTW (log-rank P < 0.05). After IPTW was used to eliminate the effect of confounders, multivariate Cox regression analysis still showed CVC was an independent risk factor for CVE (HR = 2.383, 95% CI 1.331~4.264, P = 0.003) and cardiovascular mortality (HR = 2.347, 95% CI 1.211~4.548, P = 0.012) in PD patients.

Conclusion: The prevalence of CVC is high in peritoneal dialysis patients. CVC is an independent risk factor for CVE and cardiovascular mortality in peritoneal dialysis patients.

Citing Articles

Predictive value of serum β2-microglobulin in cardiac valve calcification in maintenance hemodialysis patients.

Shen Y, Chen J, Yao W, Feng S, Yang H, Chen D J Thorac Dis. 2023; 15(9):4914-4924.

PMID: 37868894 PMC: 10586954. DOI: 10.21037/jtd-23-1185.

Soluble urokinase plasminogen activator receptor is associated with cardiovascular calcification in peritoneal dialysis patients.

Guan J, Gong S, He Q, Wang X, Shen S, Wu X Int Urol Nephrol. 2023; 56(1):191-198.

PMID: 37195572 DOI: 10.1007/s11255-023-03623-z.

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