INCIDENCE AND EVOLUTION OF AORTIC-STENOSI S IN CHRONIC-HEMODIALYSIS PATIENTS - AN ECHOCARDIOGRAPHIC AND BIOLOGICAL STUDY OF 112 PATIENTS

Valvular calcification in chronic haemodialysis patients has already b een reported in the literature, particularly the abnormally high incid ence of aortic stenosis. In this study, 112 haemodialysis patients wer e followed up by Doppler echocardiography for a period of 36 months. S ixteen patients developed aortic valvular calcification with aortic st enosis over an 18.7 +/- 7.5 months period. The indexed aortic valve su rface area decreased from 1.24 +/- 0.9 cm(2)/m(2) to 0.66 +/- 0.21 cm( 2)/m(2) with abnormally rapid progression. Eight patients with aortic stenosis died during the 3 year study period. These results reflect th e abnormal extra-skeletal calcification of chronic haemodialysis patie nts. Several predisposing factors were demonstrated : age (68.5 +/- 11 .1 years versus 57.1 +/- 16.3 years in patients without calcifications ), male gender, a longer period of dialysis than the patients without aortic stenosis (8.1 +/- 5.3 versus 5.9 +/- 5.7 years), abnormalities of calcium and phosphate metabolism, increased of the phosphocalcic pr oduct by hyperphosphoraemia and not by hypercalcaemia, hypoparathyroid ism in 62% and hyperparathyroidism in 38% an increase in vitamin D 3 ( 19.7 +/- 14 ng/ml versus 9.6 +/- 6.3 ng/ml) biological signs of adynam ic osteodystrophy. Calcific aortic stenosis is a commonly observed val vular lesion in haemodialysis patients: its progression may be very ra pid, associated with a poor prognosis. Old age, male gender, duration of haemodialysis, hyperphosphataemia associated with hypoparathyroidis m and raised Vitamin D3 are predisposing factors.