High Prevalence of Aortic Valve Alterations in Haemodialysis Patients Is Associated with Signs of Chronic Inflammation

Abstract

Aims: Cardiovascular morbidity is high in chronic haemodialysis patients. Previous studies showed a relation between uraemia-associated inflammation and cardiovascular mortality. This study intends to relate chronic inflammation to ultrasonographic markers of atherosclerotic cardiac or vascular alterations. Methods: Complete echocardiographic status and sonography of the common carotid arteries with measurement of intima media thickness (IMT) was performed in 55 stable chronic haemodialysis patients and 15 patients with arterial hypertension and normal renal function (controls). C-reactive protein (CRP) was determined monthly. The number of cardiovascular events after initiation of haemodialysis treatment was recorded by analysis of the patient’s files. Results: Aortic valve sclerosis was found in 19 dialysis patients (34%) and 1 control (6%), haemodynamically relevant stenosis in additional 14 patients (25%) and 1 control. Carotid IMT thickening was frequent in both dialysis patients (38%) and controls (20%). Aortic stenosis was associated with chronically elevated CRP levels while aortic sclerosis and thickening of the carotid wall were not. Eleven patients had cardiovascular events in their history, tightly associated with chronically elevated CRP levels. Conclusions: Chronic inflammation in dialysis patients is associated with aortic valve stenosis and high prevalence of cardiovascular events but not with thickening of the carotid wall. This suggests pathogenetic differences between destructive vascular disease and arterial wall thickening.