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Circ Cardiovasc Interv. 2015 Feb;8(2):e002220. doi: 10.1161/CIRCINTERVENTIONS.114.002220.

Moderate and severe preoperative chronic kidney disease worsen clinical outcomes after transcatheter aortic valve implantation: meta-analysis of 4992 patients.

Author information

1
From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.).
2
From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.). espogiov@unina.it.

Abstract

BACKGROUND:

There is a conflicting evidence on safety and efficacy of transcatheter aortic valve implantation in patients with preoperative chronic kidney disease (CKD). Therefore, we conducted a meta-analysis on the impact of CKD on outcomes after transcatheter aortic valve implantation.

METHODS AND RESULTS:

Nine studies including 4992 patients were analyzed. Overall preoperative CKD (stages 3-5) significantly increased early (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.08-1.94 and OR, 1.66; 95% CI, 1.04-2.67) and 1-year (OR, 1.66; 95% CI, 1.23-2.25 and OR, 1.32; 95% CI, 1.06-1.63) all-cause and cardiovascular mortality, respectively. Moderate CKD (stage 3) alone also increased early and 1-year all-cause mortality (OR, 1.43; 95% CI, 1.10-1.85 and OR, 1.41; 95% CI, 1.13-1.74). CKD stages 4 to 5 and 3 compared with stages 1 to 2 increased early stroke (OR, 2.67; 95% CI, 1.53-4.65 and OR, 1.66; 95% CI, 1.09-2.52), acute kidney injury (OR, 2.09; 95% CI, 1.17-3.72 and OR, 1.32; 95% CI, 1.09-1.60) and need for dialysis (OR, 5.92; 95% CI, 2.46-14.27 and OR, 1.55; 95% CI, 0.65-3.70), in the absence of significant differences in contrast medium administration (mean difference, -26.07; 95% CI, -53.00 to 0.85 and mean difference, -0.42; 95% CI, -16.10 to 15.26). Bleeding (life-threatening or major) was nonsignificantly increased in CKD 3 to 5 compared with CKD 1 to 2, but significantly increased in most severe patients (CKD 4-5 versus CKD 1-2: OR, 1.66; 95% CI, 1.13-2.44; CKD 4-5 versus CKD 3: OR, 1.68; 95% CI, 1.27-2.24).

CONCLUSIONS:

Both moderate and severe preoperative CKD significantly worsen transcatheter aortic valve implantation prognosis. Future studies on risk evaluation, prevention, and postoperative management are needed.

KEYWORDS:

chronic kidney disease; prognosis; renal function; transcatheter aortic valve implantation

[Indexed for MEDLINE]

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