Association between microinflammatory state and cardiac valvular calcification in patients undergoing maintenance hemodialysis: a single-centre observational study

To investigate the association between microinflammatory state and cardiac valvular calcification (CVC) in maintenance hemodialysis (MHD) patients, and to compare the predictive value of the C-reactive protein-albumin-lymphocyte (CALLY) index with conventional inflammatory and nutritional biomarkers for CVC severity. This single-center cross-sectional study enrolled 203 MHD patients. Patients were categorized by echocardiography into no CVC ( n = 67), single valve calcification ( n = 69), and double valve calcification ( n = 67) groups. Serum levels of hs-CRP, IL-6, TNF-α, and routine biochemical parameters were measured. The CALLY index, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) were calculated. Multinomial logistic regression, model fit indices, net reclassification improvement (NRI), integrated discrimination improvement (IDI), receiver operating characteristic (ROC) curves, and bootstrap internal validation were utilized to evaluate the comparative and incremental performance of the biomarkers. The prevalence of CVC in the study population was 67.0%. Multinomial logistic regression analysis demonstrated that after adjusting for the six clinical covariates (age, gender, dialysis vintage, serum phosphorus, active vitamin D dosage, and phosphate binders), the CALLY index was independently associated with both single valve calcification (OR = 0.680, P = 0.005) and double valve calcification (OR = 0.527, P < 0.001). The CALLY index also exhibited the highest C-statistic for CVC (0.869). In NRI/IDI analyses, the CALLY index significantly improved both continuous NRI (0.435, P = 0.001) and IDI (0.034, P = 0.004) for double valve calcification and CVC, whereas NLR, IL-6, and hs-CRP did not. The CALLY index is independently associated with CVC severity in MHD patients. Incorporating the CALLY index into standard clinical parameters provides significant incremental predictive value for identifying multi-valvular involvement.