True Love: Heart Says To The Kidneys ‘Don’t Fail Me’

Authors

Greeshma Molugu, HCA HealthcareFollow
Srinivasan Rajaganapathy, HCA HealthcareFollow
Machaiah Madhrira, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Fort Worth

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2026

Keywords

valvular calcification, end-stage renal disease, ESRD, mitral valve replacement, mitral stenosis

Disciplines

Cardiovascular Diseases | Internal Medicine | Male Urogenital Diseases | Medicine and Health Sciences

Abstract

Introduction: Valvular calcification is an increasingly important cardiac valvular pathology in end-stage renal disease (ESRD) patients, most frequently involving the aortic and mitral valves. The incidence/prevalence of mitral annular calcification in ESRD patients is about 30%, with mitral stenosis occurring in less than 5%. Various predisposing factors for valvular calcification in ESRD patients include age (median age >/= 60 years), hypertension, diabetes, use of calcitriol and calcium-containing phosphate binders, secondary hyperparathyroidism and duration of dialysis (median duration of >/= 5 years). We present a rare case of a young male with ESRD on peritoneal dialysis (PD) for less than two years, who developed severe mitral stenosis requiring mechanical mitral valve replacement (MVR).

Case description: A 30-year-old male with ESRD secondary to hypertension who was on PD for less than two years presented with volume overload and exertional dyspnea. His symptoms did not show significant improvement despite the adjustment of his PD prescription. Transthoracic echocardiography (TTE) revealed an ejection fraction (EF) of 55-60%, mitral annular and valvular calcification with severe mitral stenosis (mitral valve area 1.2 cm2, mean gradient 19mm Hg). TTE performed a year ago showed a similar EF with only mild calcification of the mitral valve without stenosis. Cardiac catheterization ruled out coronary artery disease and confirmed the findings of severe mitral stenosis for which the patient underwent mechanical mitral valve replacement with intraoperative histology confirming the presence of extensive mitral valvular calcification.

Discussion/Conclusion: Cardiac valvular calcification is a strong and independent predictor for all-cause mortality and cardiovascular death in ESRD patients. It is also associated with various complications, including chamber dilation leading to arrhythmias, risk for thrombosis/bleeding, and infective endocarditis. It has been established that the rate of valvular calcification is accelerated in ESRD patients compared with the general population. Calcification can be up to tenfold faster in ESRD patients compared with patients with milder stages of chronic kidney disease (CKD) not undergoing dialysis. Clinical diagnosis based on physical examination can be challenging due to the labile volume status of patients undergoing dialysis. Hence, a high index of suspicion should be applied to perform echocardiography to detect valvular calcification and valvular stenosis, especially in the presence of symptoms. This case report is unique as the development of severe calcific mitral stenosis requiring intervention was in a young male who was on peritoneal dialysis for less than two years. It also highlights the rapid progression of the valvular abnormality, thus emphasizing the importance of early referral to cardiology, and guideline-directed management, including follow-up echocardiograms to reduce mortality and morbidity.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Molugu, Greeshma; Rajaganapathy, Srinivasan; and Madhrira, Machaiah, "True Love: Heart Says To The Kidneys ‘Don’t Fail Me’" (2026). North Texas Research Forum 2026. 18.
https://scholarlycommons.hcahealthcare.com/northtexas2026/18