Burden of Valvular Heart Disease Diagnosed on Protocolised Echocardiography for Waitlist Placement in End-Stage Kidney Patients.

AIM: The burden of valvular heart disease (VHD), which is high amongst end-stage kidney disease patients (ESKD), is less well defined in those referred to the transplant waitlist. We aimed to determine the prevalence, incidence, impact on survival and risk factors of VHD in ESKD patients who are referred for deceased donor kidney transplant (DDKT). METHODS: This is a single-centre retrospective cohort analysis of ESKD patients who were referred for waitlist placement between 2009 and 2017 and underwent at least 1 transthoracic echocardiogram (TTE), then followed up until death or transplantation. Significant VHD was defined as VHD that was moderate or worse in severity as assessed on echocardiography. RESULTS: Of the 512 patients included, 89 (17.4%) had significant baseline VHD. Over a median follow-up of 6.6 years, severe VHD (adjusted HR (aHR) 2.73, 95% CI 1.28-5.83, p = 0.009), severe tricuspid regurgitation (aHR 3.04, 95% CI 1.20-7.69, p = 0.02), significant aortic stenosis (aHR 2.93, 95% CI 1.15-7.45, p = 0.02), MS (aHR 3.83, 95% CI 1.54-9.50, p = 0.004) and AR (aHR 1.76, 95% CI 1.05-2.97, p = 0.03) were independently associated with all-cause mortality. In 350 patients with repeat TTEs, 53 (15.1%) developed de novo significant VHD or progression of pre-existing VHD, which was independently associated with all-cause mortality (aHR 2.02, 95% CI 1.14-3.61, p = 0.02). Age, time on dialysis, and mineral bone disease were associated with baseline VHD and de novo or progression of pre-existing VHD. CONCLUSION: VHD is common amongst ESKD patients referred for DDKT waitlist. Both baseline and progressive VHD predict worse survival.