Chronic Kidney Disease and Aortic Stenosis

Direct correlation

Much is discussed about the risk factors for the development of senile aortic stenosis calcification and the risk factors traditionally linked to coronary heart disease have also been shown to correlate with calcification of the aortic valve and its adjacent structures.

Final stages of kidney disease, such as dialysis patients, had this clearer association established in the literature, but several research services sought a cutoff value for creatinine clearance in which the risk of developing aortic stenosis would be clinically significant.

As it is a group of patients rich in several comorbidities, several studies have failed to demonstrate a clear correlation between CKD and aortic stenosis, due to the number of study participants. Recently a giant cohort from northern Europe, with more than 1 million patients, came to elucidate the data between these variables.

An inverse correlation between glomerular filtration rate and aortic valve calcification was demonstrated. The novelty of this study is to bring information that, even in the presence of non-dialysis patients, there is a progressive worsening of clearance and a higher incidence of aortic valve stenosis. In this range of kidney disease, the correlation was uncertain due to the confounding factors mentioned in the paragraph above.

Dialysis patients have a higher incidence of valve disease and more, they have a higher rate of progression to severe aortic stenosis. This was justified by the intense dysfunction in mineral metabolism found in this group of patients.

However, some data were not clarified by this study, such as whether there was a clinical manifestation at any point in the downward curve of the filtration rate. As there were no hemodynamic data on the aortic valve, it was not possible to establish a correlation between the intensity of both chronic kidney disease and aortic stenosis. Only the existence of the latter in greater prevalence at lower filtration rates.

Another information that is still obscure in the literature is whether chronic kidney disease is capable of initiating the process of aortic calcification or of only progressing an already started process. As the follow-up was only 5 years in this cohort and the data do not make it clear whether some individuals developed valve sclerosis during this period, we still lack this information to better understand the pathophysiology of these diseases.

Here is a question: could it be that intervening in early stages of both chronic kidney disease and aortic stenosis could slow or stop the progression of valve calcification? Only other studies can answer that…

Suggested literature:

1 – Vavilis G, Bäck M, Occhino G, et al. Kidney Dysfunction and the Risk of Developing Aortic Stenosis. J Am Coll Cardiol. 2019; 73 (3): 305‐314.

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