Korean J Transplant.  2023 Nov;37(Suppl 1):S57. 10.4285/ATW2023.F-6263.

Valvular heart disease in end-stage kidney disease patients on the transplant waitlist

• Lye YN
• Ho QY
• Koh CH
• Chen H
• Carolyn Tien SY
• Liew IT
• Thangaraju S
• Jin Chua TS
• Kee T
• Keh YS

• KMID: 2551644
• DOI: http://doi.org/10.4285/ATW2023.F-6263

Abstract

Background
Valvular heart disease (VHD) is a risk factor for adverse outcomes in end-stage kidney disease (ESKD) patients but its impact on patients on the local kidney transplant waitlist is unclear. We hypothesize that VHD is an independent risk factor for mortality in our ESKD patients on the transplant waitlist.
Methods
This is a single-center retrospective cohort study including ESKD patients who were referred for transplant waitlist placement from May 2008 to February 2021 and had undergone transthoracic echocardiogram (TTE). Significant VHD was de-fined as valvular lesions that were moderate or severe on TTE.
Results
Of the 512 patients included, 89 (17.4%) had significant VHD. The most common significant valvular lesions were tri-cuspid regurgitation (9.0%), mitral regurgitation (MR; 8.6%), and aortic regurgitation (2.1%). VHD was associated with longer median dialysis duration (38.0 vs. 18.0 months, P=0.04). All-cause mortality was associated with presence of any significant VHD (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.01–2.36; P=0.04), left-sided VHD (LVHD) (HR, 1.76; 95% CI, 1.10–2.81; P=0.02) and aortic stenosis (AS; HR, 5.80; 95% CI, 2.36–14.3; P<0.0001) and remained significant after adjustment for age, dia-betes mellitus and history of cardiovascular disease (VHD: adjusted HR [aHR] 1.57, 95% CI 1.02–2.42, P=0.04; LVHD: aHR 1.92, 95% CI 1.19–3.10, P=0.01; AS: aHR 2.93, 95% CI 1.15–7.46, P=0.02). With noncardiovascular mortality as a competing event, LVHD (sub-distribution HR [SHR], 2.54; 95% CI, 1.13–5.70; P=0.03) and MR (SHR 2.94; 95% CI, 1.27–6.84; P=0.02) were signifi-cantly associated with cardiovascular mortality and remained significant after adjustment for age, diabetes mellitus and history of cardiovascular disease (LVHD: aSHR 2.68, 95% CI 1.15–6.24, P=0.02; MR: aSHR 3.33, 95% CI 1.38–8.03, P=0.007).
Conclusions
VHD, particularly AS and MR, may be an independent risk factor for mortality in ESKD patients on the kidney transplant waitlist. Prolonged dialysis may be associated with VHD.