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JACC Cardiovasc Interv. 2017 Oct 23;10(20):2050-2060. doi: 10.1016/j.jcin.2017.07.044.

Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve Replacement.

Author information

1
Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
2
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
3
Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
4
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
5
Division of Cardiology, New York University Langone Medical Center, New York, New York.
6
Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York.
7
Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
8
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. Electronic address: dlbhattmd@post.harvard.edu.

Abstract

OBJECTIVES:

This study sought to determine the association of chronic kidney disease (CKD) with in-hospital outcomes of transcatheter aortic valve replacement (TAVR).

BACKGROUND:

CKD is a known independent risk factor for worse outcomes after surgical aortic valve replacement (SAVR). However, data on outcomes of patients with CKD undergoing TAVR are limited, especially in those on chronic dialysis.

METHODS:

The authors used data from the 2012 to 2014 National Inpatient Sample database to identify all patients ≥18 years of age who underwent TAVR. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with no CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on long-term dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes.

RESULTS:

Of 41,025 patients undergoing TAVR from 2012 to 2014, 25,585 (62.4%) had no CKD, 13,750 (33.5%) had CKD, and 1,690 (4.1%) had ESRD. Compared with patients with no CKD, in-hospital mortality was significantly higher in patients with CKD or ESRD (3.8% vs. 4.5% vs. 8.3%; adjusted odds ratio [no CKD as reference]: 1.39 [95% confidence interval: 1.24 to 1.55] for CKD and 2.58 [95% confidence interval: 2.09 to 3.13] for ESRD). Patients with CKD or ESRD had a higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke), net adverse cardiovascular events (composite of major adverse cardiovascular events, major bleeding, or vascular complications), and pacemaker implantation compared with patients without CKD. Acute kidney injury (AKI) and AKI requiring dialysis were associated with several-fold higher risk-adjusted in-hospital mortality in patients in the no CKD and CKD groups. Moreover, the incidence of AKI and AKI requiring dialysis did not decline during the study period.

CONCLUSIONS:

Patients with CKD or ESRD have worse in-hospital outcomes after TAVR. AKI is associated with higher in-hospital mortality in patients undergoing TAVR and the incidence of AKI has not declined over the years.

KEYWORDS:

acute kidney injury; chronic kidney disease; end-stage renal disease; in-hospital mortality; major adverse cardiovascular event(s); transcatheter aortic valve replacement

PMID:
29050621
DOI:
10.1016/j.jcin.2017.07.044
[Indexed for MEDLINE]
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