Arq. Bras. Cardiol. 2025; 122(8): e20250376
Beyond Atherosclerosis: Mind the Valves in Chronic Kidney Disease
This Short Editorial is referred by the Research article "Clinical and Laboratory Predictors for the Development of Heart Valve Diseases in Chronic Kidney Disease: A Systematic Review".
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with chronic kidney disease (CKD), far surpassing the risk of progression to end-stage renal disease, and accounting for approximately 40% to 50% of all deaths in the advanced stages.– Growing attention has been directed toward the intersection of renal dysfunction and valvular heart disease (VHD), which plays a major role in the cardiovascular complications and adverse outcomes observed in this population., Valvular calcification, particularly affecting the aortic and mitral valves, is the hallmark manifestation of VHD in this setting, representing a highly prevalent, progressive, and prognostically significant process driven by disordered mineral metabolism, its crosstalk with persistent inflammation, and the toxic uremic milieu., Despite growing acknowledgment of its clinical impact, the biological underpinnings remain incompletely understood, even as emerging evidence begins to clarify the processes driving valvular calcification in CKD.
While several mechanistic pathways have been identified, robust clinical and laboratory markers that predict its development remain elusive. In this regard, the study by Conceição et al. offers valuable insight into the factors associated with valvular calcification, helping to address a relevant blind spot in current knowledge and underscoring the need for continued research into its clinical implications and underlying mechanisms in this high-risk population. Their systematic review was based on twenty observational studies involving 13,314 patients from varied geographic contexts, including individuals both on and off dialysis. Most were cross-sectional in design, with fewer cohort studies and a single case-control study, reflecting the predominantly descriptive and observational nature of the available evidence. The breadth of the population analyzed, combined with the methodological rigor adopted, offers a comprehensive overview of the existing body of evidence in this still underexplored domain. Among the thirty-eight risk factors identified, advanced age (tipically above 55 years),was the most consistently associated with valvular calcification, reported in half of the studies reviewed. These findings lend further support to the concept that ageing represents a major determinant in valvular degeneration in CKD, as it does in the broader context of age-related valve disease in the general population.
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