Malnutrition as a risk factor for cardiac valve calcification in patients under maintenance dialysis: a cross-sectional
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NEPHROLOGY - ORIGINAL PAPER
Malnutrition as a risk factor for cardiac valve calcification in patients under maintenance dialysis: a cross‑sectional study Petrini Plytzanopoulou1 · Marios Papasotiriou2 · Panayiotis Politis3 · Christophoros Parissis3 · Pinelopi Paraskevopoulou4 · Ioannis Kehagias5 · Dimitrios S. Goumenos2 · Evangelos Papachristou2 Received: 4 April 2020 / Accepted: 27 July 2020 © Springer Nature B.V. 2020
Abstract Purpose Cardiac valve calcification (CVC) is a significant risk factor for cardiovascular morbidity and mortality in patients with chronic kidney disease on maintenance hemodialysis. The aim of this study was to investigate the association of several risk factors and particularly of malnutrition on CVC. Methods In this cross-sectional cohort study, we included stable adult patients on maintenance hemodialysis. Calcification of cardiac valves was evaluated using two-dimensional echocardiography. Nutritional assessment and body composition measurements were performed using the MQSGA clinical tool and bioelectrical impedance analysis, respectively. Biochemical parameters such as serum calcium, phosphorus, iPTH, 1.25 hydroxy-vitamin-D, triglycerides, total cholesterol, HDL-C, LDL-C, total proteins, albumin, creatinine and CRP were assessed as potentially risk factors. The receiver operating characteristic (ROC) curve analysis was used to evaluate the prognostic ability of the aforementioned variables on severe degree CVC. Binary logistic regression analysis was also performed to identify independent variables of severe CVC. Results Overall, 42 patients were included in the study with half of them exhibiting mitral calcification, 38% aortic valve calcification, and 16.7% calcification in both valves. ROC analysis indicated that aging (p = 0.011), increased CRP (p = 0.038) and decreased value of serum albumin to total proteins ratio (p = 0.012) were positive prognostic factors for moderate to severe degree cardiac valve calcification. Low phase angle was also associated with CVC, although with moderate specificity. Conclusion Aging, inflammation, low serum albumin to total proteins ratio and low phase angle values as indicators of malnutrition are predictors of severe CVC in end-stage renal disease patients on hemodialysis. Keywords Cardiac valve calcification · End-stage kidney disease · Malnutrition · Serum albumin to total protein ratio
Introduction
* Dimitrios S. Goumenos [email protected] 1
Department of Nutrition, “Konstantopouleio” General Hospital of Athens, Athens, Greece
2
Department of Nephrology and Renal Transplantation, University Hospital of Patras, Patras, Greece
3
Department of Nephrology, “Konstantopouleio” General Hospital of Athens, Athens, Greece
4
Department of Biochemistry, “Konstantopouleio” General Hospital of Athens, Athens, Greece
5
Department of Surgery, University Hospital of Patras, Patras, Greece
Cardiac valve calcification (CVC) is a common disorder in patients with chronic kidney disease and its prevalence in end-stage renal diseas
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