**4.2. Degenerative heart valve disease (DHVD)**

Patients with ESRD have increased incidence of degenerative disease of the heart valves, which is one of the major risks of IE. The calcific aortic stenosis and mitral annular calcification with consequent failure are the most common diseases. It has been found that this condition occurs prematurely in this group of patients 10–20 years prior to the general population. Degenerative heart valve disease is caused due to disorders of calcium and phosphorus homeostasis, in the setting of secondary hyperparathyroidism, and due to the chronic micro-inflammatory milieu of uremia associated with ESRD [5].
