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Background: Abnormalities of the aortic valve occur with increased frequency in patients with renal failure and may contribute to the observed excess cardiovascular mortality. Little data exist on the rate at which aortic stenosis progresses in this patient group. Methods: A retrospective case-control study was designed to compare the rate of progression of aortic stenosis in dialysis patients with that in sex-matched controls. Dialysis patients with aortic stenosis were identified by a search of the echocardiography database. Twenty-eight dialysis patients were compared to 56 sex-matched controls, all of whom had aortic stenosis on at least two echocardiograms 6 months apart. Changes in mean and peak transvalvular gradient as well as valve area were calculated from echocardiographic data and compared. Results: Aortic stenosis progressed more rapidly in the dialysis patients than in the controls when measured by change in valve area (–0.19 vs. –0.07 cm2/year; p < 0.001) and change in peak transvalvular gradient (6.5 vs. 3.9 mm Hg/ year; p = 0.04). There was also a trend towards more rapid progression of mean transvalvular gradient (4.9 vs. 2.5 mm Hg/year; p = 0.052). On multivariate linear regression analysis, only end-stage renal failure (p = 0.02) and baseline valve area (p = 0.04) predicted accelerated progression of aortic stenosis. Conclusions: Aortic stenosis progressed more rapidly in the presence of renal failure. The time frames for review and operation in dialysis patients should be shorter than for the general population.

SUMMARY: Background: Atherosclerosis and Folic Acid Supplementation Trial (ASFAST) is a randomized placebo controlled trial assessing whether high-dose folic acid can reduce cardiovascular events and atherosclerosis progression in patients with chronic renal failure (CRF). Here we report the baseline results and compare indices of arterial structure (carotid intima-medial thickness (IMT)) and function (systemic arterial compliance (SAC)), pressure augmentation index (AI x ) and pulse wave velocity (PWV a-f and PWV f-d)) to age- and sex-matched controls. Methods: Three hundred and fifteen subjects with CRF (serum creatinine ≥ 0.40 mmol/L) aged 24‐ 79 years (mean ± SD: 56.6 ± 13.6 years) and 213 healthy controls (58.2 ± 10.2 years) were studied. Fasting blood samples were assayed for lipids (both groups), total homocysteine (tHcy), red cell folate, cobalamin and fibrinogen (CRF group). Ultrasound B mode measurements were used to determine mean carotid IMT and applanation tonometry techniques to determine SAC, AI x , PWV (a-f), PWV (f-d) and central pressures. Results: Ninety-six per cent of the CRF group had at least one of: hypertension, hypercholesterolaemia, diabetes or smoking; 35% had established cardiovascular disease. The mean IMT was greater in CRF patients than in controls (0.86 ± 0.19 vs 0.68 ± 0.11 mm, P < 0.001). The SAC was significantly lower, and PWV (a-f) and AI x significantly higher. The tHcy was increased in 97% of the CRF group (27.3 ± 2.9 m mol/L (normal < 13)). Total homocysteine did not correlate with IMT or any other measure of arterial function. However, those in the upper quantile of tHcy ( ≥ 25 m mol/L) did have higher PWV (a-f) and lower SAC than those in the lower quantile. Conclusions: Compared to normals, patients with CRF exhibited a 10‐15-year shift to the right in age-related increases in carotid IMT and PWV (a-f), and significantly increased central pressure augmentation. This 5-year study is examining the impact of high-dose folic acid therapy on cardiovascular end-points, IMT progression and arterial function in CRF.

Excerpt Goodpasture's syndrome is an autoimmune disease of unknown aetiology. Viral and streptococcal infections (1, 2) and exposure to hydrocarbon fumes (3) have been suggested as possible causal ...