Photo Credit: Tonpor Kasa

The following is a summary of “Mitral Regurgitation in Patients With Chronic Kidney Disease: Results From the Chronic Renal Insufficiency Cohort Study,” published in the November 2023 issue of Cardiology by JIN et al.

Despite the increased prevalence of mitral regurgitation (MR) in chronic kidney disease (CKD), its long-term impact on mortality and heart failure (HF) remains unclear.

Researchers started a retrospective study to investigate the prevalence of mitral regurgitation in chronic kidney disease and its long-term association with mortality, heart failure, and atrial fibrillation (AF).

They examined patients with CKD who underwent echocardiography exams (2008-2013) as part of the Chronic Renal Insufficiency Cohort (CRIC) study. Independent t-tests & Chi-square tests reveal clinical & echo differences in MR patients. The MR degree was quantified using the effective regurgitant orifice area (EROA) from the apical-four chamber view, further classified as trace, mild, and moderate/severe. Utilized KM curves and Cox models to examine the relationship between MR degree, EROA, mortality, HF, and AF incidence.

The results showed 2,951 patients with CKD, 73.4% (2,167 patients) had MR with an EROA of 0.14±0.19 cm². The trace, mild, and moderate/severe MR degrees constituted 54.3%, 12.5%, and 6.6%, respectively. Patients with MR were more likely to be female (47.39% vs. 42.73%), of non-White race (51.8% vs. 46.8%), and exhibited worse B-type Natriuretic Peptide (NTproBNP; 524.86 vs. 271.66 pg/ml) and left ventricular ejection fraction (53.7% vs. 55.8%) compared to those without MR. Stratifying by estimated glomerular filtration rate (eGFR; 60-45, 45-30, <30 ml/min/1.73 m²), the lowest eGFR category (n=703) had the highest prevalence of moderate/severe MR (9.2%, P<0.05). KM curves demonstrated that patients with CKD and moderate/severe MR had a higher incidence of HF and AF than those with CKD and absent, trace, or mild MR (P<0.01). EROA was associated with the incidence of AF (hazard ratio [HR] = 1.08, P<0.01) and HF (HR=1.06, P<0.01), independent of age, sex, race, traditional cardiovascular risk factors, urine albumin-to-creatinine ratio, eGFR, and NTproBNP, but not mortality.

They concluded that CKD patients with MR had higher heart failure and atrial fibrillation, suggesting targeted interventions for MR are crucial.

Source: ahajournals.org/doi/10.1161/circ.148.suppl_1.15660