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Am J Cardiol. 2017 Oct 15;120(8):1355-1358. doi: 10.1016/j.amjcard.2017.07.022. Epub 2017 Jul 25.

In-Hospital Outcomes of Transcatheter Aortic Valve Implantation in Patients With End-Stage Renal Disease on Dialysis from a Large National Database.

Author information

1
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: dr.bhatia.n@gmail.com.
2
Division of Cardiovascular Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania.
3
Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
4
Division of Cardiovascular Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
5
Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
6
Division of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania.
7
Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
8
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

Abstract

The outcomes of patients with end-stage renal disease on dialysis (chronic kidney disease stage 5 on dialysis [CKD 5D]) who undergo transcatheter aortic valve implantation (TAVI) are not well described due to the exclusion of this group in randomized trials. We analyzed the National Inpatient Sample database and compared clinical characteristics and in-hospital outcomes for patients with CKD 5D versus those without CKD 5D (nondialysis group) who underwent TAVI in 2011 to 2014 in the United States. The study population included 1,708 patients (4%) with CKD 5D and 40,481 patients (96%) without CKD 5D who underwent TAVI. Patients with CKD 5D were younger (75.3 ± 9.9 vs 81.4 ± 8.4 years, p <0.001), more likely to be men (62.8% vs 52%, p <0.001), and less likely to be Caucasian (73.6% vs 87.8%, p <0.001). Patients with CKD 5D were more likely to have congestive heart failure (16% vs 11.7%, p <0.001), diabetes with chronic complications (19% vs 5.4%, p <0.001), hypertension (86.5% vs 79.3%, p <0.001), and peripheral vascular disease (34.5% vs 29.4%, p <0.001), but were less likely to have atrial fibrillation (38.6% vs 44.8%, p <0.001) and chronic pulmonary disease (27.5% vs 33.6%, p <0.001). In-hospital mortality was significantly higher in the dialysis group (8.2% vs 4%; adjusted odds ratio 2.21, 95% confidence interval1.81 to 2.69, p <0.001) after adjusting for age, gender, co-morbidities, and hospital characteristics in a robust multivariate regression model. In conclusion, patients with CKD 5D who undergo TAVI have a higher in-hospital mortality than those without CKD 5D.

PMID:
28823478
DOI:
10.1016/j.amjcard.2017.07.022
[Indexed for MEDLINE]

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