Association between polycystic kidney disease and valve disease: a nationwide population-based nested case-control study

Polycystic kidney disease (PKD) is a systemic disorder with recognized cardiovascular manifestations; however, its association with valvular heart disease remains incompletely defined. This study evaluated the association between PKD and valvular heart disease in a nationwide population-based setting. This nationwide population-based nested case-control study included 331,125 individuals, comprising 66,225 patients with valvular heart disease and 264,900 matched controls. valvular heart disease was identified using ICD-10-CM diagnostic codes, and PKD exposure was defined using diagnostic codes for autosomal dominant or unspecified polycystic kidney disease. Conditional logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals after adjustment for demographic, socioeconomic, clinical, and healthcare-related variables. Subgroup analyses, temporal analyses based on time since PKD diagnosis, and cumulative exposure analyses were performed to assess robustness of the association. The prevalence of PKD was higher in patients with valvular heart disease compared with controls (0.37% vs. 0.21%, p < 0.001). After multivariable adjustment, PKD was associated with higher odds of valvular heart disease (aOR = 1.609, 95% CI 1.217-2.038, p < 0.001). This association remained consistent across demographic and clinical subgroups, with higher estimates observed in men, older individuals, and patients with cardiometabolic or psychiatric comorbidities. A temporal pattern was observed, with adjusted odds ratios of 2.016 within 1 year, 1.731 at 1-5 years, and 1.532 at ≥ 5 years after PKD diagnosis. A cumulative exposure-response pattern was also identified, with aORs of 1.553, 1.832, and 2.003 across increasing exposure duration categories. The higher odds observed in the early period after PKD diagnosis may partly reflect increased diagnostic surveillance; however, the persistence of elevated odds over time supports a robust epidemiological association. PKD was associated with higher odds of clinically recognized valvular heart disease in this nationwide population-based study. Temporal and exposure-response patterns were observed, although causality cannot be inferred due to the observational design. These findings suggest that PKD may be associated with broader cardiovascular involvement beyond renal manifestations. Routine echocardiographic screening is not supported by the present evidence; however, clinicians may consider targeted cardiovascular evaluation in selected high-risk patients.