VALVULAR HEART-DISEASE IN END-STAGE RENAL-FAILURE PATIENTS ON MAINTENANCE HEMODIALYSIS

Objective: To determine the presence of, and factors associated with, valvular heart disease in end-stage renal failure patients by M-mode, two-dimensional and Doppler echocardiography. Design: Case series of a n unselected group of patients on maintenance haemodialysis. Setting: Haemodialysis unit and echocardiography laboratory of the King Fahd Ce ntral Hospital, Gizan, Saudi Arabia. Subjects: Sixty patients on haemo dialysis for at least 6 months. Main outcome measures: Detection of fu nctional and structural valve abnormalities and their relation to puta tive aetiological factors. Results: The mean age was 34.4 (SD13.0), ra nge 14-66 years; 31 (51.7%) were men and 29 women. The duration of dia lysis was 37 (SD 29) months with a range of 6-106 months. Mitral regur gitation was found in 20 (33.3%), mitral annular calcification in 3 (5 .0%), aortic valve calcification in 5 (8.3%) and tricuspid regurgitati on in 8 (13.3%) patients. At least one of these lesions was present in 22 (36.7%) patients. No patient had mitral or aortic stenosis. There were significant associations found between left ventricular mass and mitral regurgitation; calcium-phosphate product and aortic valvular ca lcification; and right ventricular enlargement and tricuspid regurgita tion. Conclusions: Mitral and tricuspid regurgitation were common in o ur dialysis patients. The calcium and phosphate product was found to b e an important determinant of aortic valvular calcification. Further s tudies are needed to determine whether early control of calcium and ph osphate levels would prevent the development of this complication.