Valve calcification may be 5 to 10 times more frequent in patients with end-stage renal disease (ESRD) in comparison with a non-renal population (3). Prevalence of 35–44.5% has been reported for mitral valve calcification (MVC) and 25–52.0% for aortic valve calcification

(AVC) in hemodialysis (HD) patients 4 and 5. Similar data were also reported in peritoneal dialysis (PD) patients (6). Heart valve calcifications are associated with other vascular pathological conditions such as atherosclerosis and vascular calcifications (7) and have also been identified as risk factors for cardiovascular morbidity and mortality. MVC was associated with atrial fibrillation, stroke, and increased morbidity and mortality of cardiovascular

origin in both the general and the CKD populations 8, 9 and 10. On the other hand, AVC was reported as a risk factor ERK inhibitor for cardiovascular morbidity and mortality (11). In spite of its high frequency and importance as a risk factor for cardiovascular mortality in CKD patients, little is known about the mechanisms and risk factors for their development. In cross-sectional studies, MVC was associated with inflammation (12) and hyperphosphatemia (4), and AVC seems to be associated with duration of HD treatment and some markers of mineral metabolism 13 and 14. However, studies about the development of new valve calcifications are not available. The aim of this study was to analyze the frequency and factors related to de novo development of MVC and AVC in incident PD patients. Enzalutamide chemical structure A prospective cohort study was performed in ESRD patients from six dialysis units in the metropolitan area of Mexico City affiliated with the national network of the Nintedanib (BIBF 1120) Instituto Mexicano del Seguro Social. The protocol was approved by the Human Research and Ethics Committees of each of the participating hospitals. Patients gave their signed informed consent before enrollment in the study. Two hundred forty-eight patients initiated PD in six hospitals participating in the study in the period between October 2009 and August 2010. Of these patients, 133 (54%) met the

inclusion criteria. Of those accepted, three died, one was lost to follow-up and five had valve calcification at baseline and were excluded; 124 patients (50%) of the total population were included in the final analysis. The patients were considered eligible for inclusion if they were incident (<3 months) on continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). All were adults (18 years or older) without selection by gender, cause of renal disease or dialysis modality. Patients were excluded if they had pre-existing heart valve calcifications, heart failure, infections, malignancy, chronic liver disease, seropositivity for hepatitis or HIV or if they received immunosuppressive treatment.