Abstract
Valvular heart calcification is common in patients with chronic kidney disease (CKD),
especially in those receiving hemodialysis therapy, and it is associated with poor
prognosis. Furthermore, progression of valvular heart disease (VHD) and structural
valve deterioration of bioprosthetic valves are faster in these patients. Mechanisms
involved in the pathophysiology of VHD are similar between patients with and without
impaired kidney function, but CKD is associated with a bone metabolism dysregulation,
which might lead to a procalcifying phenotype within vessels and heart valves. CKD
is also associated with left ventricular remodelling and dysfunction, which might
contribute to increase the risk of heart failure and death in patients with VHD. Even
if promising pharmacotherapeutic avenues are in development, no medical treatment
can prevent or reduce the valvular calcific process. Patients with advanced CKD should
undergo transthoracic echocardiography for detection of VHD, and if present, follow-up
should be more frequent than what is recommended in the guidelines. Transcatheter
valve replacement might be preferred over surgical replacement in patients with CKD
and severe aortic valve stenosis.
Résumé
Les calcifications valvulaires sont fréquentes chez les atteints d’ isufisance rénale
chronique, surtout en cas d’hémodialyse, et leur présence est associée à un mauvais
pronostic. De plus, la progression des valvulopathies et la détérioration des bioprothèses
sont accélérées dans cette population. Les mécanismes physiopathologiques impliqués
dans le développement des valvulopathies sont similaires entre les patients avec et
sans insuffisance rénale, cependant la dérégulation du métabolisme osseux est plus
prononcée en cas de néphropathie, d’où un phénotype pro-calcifiant. L’insuffisance
rénale entraine également un remodelage et une altération de la fonction du ventricule
gauche, ce qui contribue à augmenter le risque d’insuffisance cardiaque et de décès
en cas de valvulopathie. Même si des pistes thérapeutiques sont en développement,
il n’existe aucun traitement médical permettant de prévenir ou de faire régresser
les calcifications valvulaires. Chez les patients atteints d’ insuffisance rénale
avancée, il est important d’effectuer une échocardiographie pour le dépistage des
maladies valvulaires et d’effectuer un suivi plus rapproché que ce qui est recommandé
dans les lignes directrices. Le remplacement valvulaire par cathéter semble être préférable
au remplacement chirurgical chez les patients atteints d’ insuffisance rénale et de
sténose aortique grave.
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Vindhyal MR, Ndunda P, Khayyat S, Boppana VS, Fanari Z. Trans-catheter aortic valve replacement and surgical aortic valve replacement outcomes in patients with dialysis: systematic review and meta-analysis [e-pub ahead of print] Cardiovasc Revasc Med. https://doi.org/10.1016/j.carrev.2018.12.002.
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Article info
Publication history
Published online: May 28, 2019
Accepted:
May 21,
2019
Received:
March 12,
2019
Footnotes
See page 1203 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
