Aortic regurgitation in renal disease
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
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Valvular/annular thickening, and calcification of heart valves occur commonly in patients undergoing dialysis, thereby leading to valvular regurgitation and/or stenosis. Hyperparathyroidism occurring secondary to renal disease is one of the most significant predisposing factor for valular calcification[1][2][3]. Aortic insufficiency is seen less common in comparison to mitral or tricuspid insufficiency [1][4]. In a study on 75 patients with end stage renal disease(ESRD) undergoing hemodialysis, 38% of patients were found to have developed aortic insufficiency[4].
Degree of regurgitation varies with alterations in preload and afterload which are dependent on:
- Volume status (has the most significant effect)
- Degree of left ventricular function
- Medications such as antihypertensives
Aortic regurgitation worsens in the setting of elevated systolic pressure and increased afterload conditions which are seen in ESRD. Attaining optimal intravascular volume and blood pressure control with aggressive ultrafiltration and antihypertensives should be the therapeutic goals in these patients because, by decreasing afterload, regurgitant fraction decreases and thereby improving left ventricular systolic function[5].
References
- ↑ 1.0 1.1 Straumann E, Meyer B, Misteli M, Blumberg A, Jenzer HR (1992). "Aortic and mitral valve disease in patients with end stage renal failure on long-term haemodialysis". British Heart Journal. 67 (3): 236–9. PMC 1024798. PMID 1554541. Retrieved 2011-04-13. Unknown parameter
|month=ignored (help) - ↑ Rubel JR, Milford EL (2003). "The relationship between serum calcium and phosphate levels and cardiac valvular procedures in the hemodialysis population". American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 41 (2): 411–21. doi:10.1053/ajkd.2003.50050. PMID 12552504. Retrieved 2011-04-13. Unknown parameter
|month=ignored (help) - ↑ Kajbaf S, Veinot JP, Ha A, Zimmerman D (2005). "Comparison of surgically removed cardiac valves of patients with ESRD with those of the general population". American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 46 (1): 86–93. PMID 15983961. Retrieved 2011-04-13. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 Stinebaugh J, Lavie CJ, Milani RV, Cassidy MM, Figueroa JE (1995). "Doppler echocardiographic assessment of valvular heart disease in patients requiring hemodialysis for end-stage renal disease". Southern Medical Journal. 88 (1): 65–71. PMID 7817230. Retrieved 2011-04-13. Unknown parameter
|month=ignored (help) - ↑ Cirit M, Ozkahya M, Cinar CS, Ok E, Aydin S, Akçiçek F, Dorhout Mees EJ (1998). "Disappearance of mitral and tricuspid regurgitation in haemodialysis patients after ultrafiltration". Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 13 (2): 389–92. PMID 9509451. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help)