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

Gupta, Tanush; Goel, Kashish; Kolte, Dhaval; Khera, Sahil; Villablanca, Pedro A.; Aronow, Wilbert S.; Bortnick, Anna E.; Slovut, David P.; Taub, Cynthia C.; Kizer, Jorge R.; Pyo, Robert; Abbott, J. Dawn; Fonarow, Gregg C.; Rihal, Charanjit S.; García, Mario J.; Bhatt, Deepak L.

doi:10.1016/j.jcin.2017.07.044

Cited by 118 publications

(105 citation statements)

References 24 publications

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“…After adjusting for patients' demographics, clinical presentation (intermittent claudication vs. CLI), comorbidities, insurance and socioeconomic status using multivariate regression mode, ESRD patients on dialysis remained at higher risk of in‐hospital mortality (adjusted OR: 2.13 [95% CI: 2.04–2.23]; Table ). Risk‐adjusted linear regression for LOS demonstrated a statistically significant longer LOS in the ESRD dialysis group (median LOS = 7 days; Interquartile range [IQR]) when compared with those with normal kidney function (median LOS = 3 days; [IQR; 0–6]; p < .001).…”

Section: Resultsmentioning

confidence: 99%

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In‐hospital outcome of peripheral vascular intervention in dialysis‐dependent end‐stage renal disease patients

Pacha

Al‐Khadra

Darmoch

et al. 2019

Cathet Cardio Intervent

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Background The impact of end‐stage renal disease (ESRD) on peripheral vascular intervention (PVI) outcome remains incompletely elucidated. Objectives We sought to compare the outcome of PVI in dialysis patients with those with normal kidney function. Methods Using weighted data from the National Inpatient Sample database between 2002 and 2014, we identified all peripheral artery disease (PAD) patients aged ≥18 years that underwent PVI. Multivariate logistic regression analysis was performed to examine in‐hospital outcomes. Results Of 1,186,192 patients who underwent PVI, 1,066,830 had normal kidney function (89.9%) and 119,362 had ESRD requiring dialysis (10.1%). Critical limb ischemia was more prevalent in dialysis patients (63.2 vs. 34.0%, p < .001). Compared with normal kidney function group, ESRD requiring dialysis was associated with higher in‐hospital mortality (1.5 vs. 4.2%, adjusted OR: 2.13 [95% CI: 2.04–2.23]) and longer length of hospital stay (median 3 days, Interquartile range [IQR] (0–6) vs. 7 days, IQR (4–18); p < .001). Dialysis patients had higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke; 14.3 vs. 9.8%, p < .001) and net adverse cardiovascular events (composite of MACE, major bleeding, or vascular complications; 40.8 vs. 29.1%, p < .001). ESRD patients less frequently underwent open bypass (5.6 vs. 8.5%, p < .001) and more frequently had major amputation (10.3 vs. 3.0%, p < .001) compared with normal kidney function group. Conclusion PAD patients on dialysis who underwent PVI have higher rates of mortality and adverse outcomes as compared to those with normal kidney function.

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Section: Resultsmentioning

confidence: 99%

“…Patients with normal kidney function was defined as those who did not have CKD, ESRD requiring dialysis, renal transplant, or acute kidney injury. This approach has been used by previous studies using the NIS database to accurately identify patients with PAD and CLI undergoing PVI, and those with ESRD on dialysis …”

Section: Methodsmentioning

confidence: 99%

In‐hospital outcome of peripheral vascular intervention in dialysis‐dependent end‐stage renal disease patients

Pacha

Al‐Khadra

Darmoch

et al. 2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

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“…However, most studies conducted prior to Hansen et al found this association insignificant. The association between stage 4 or 5 CKD and increased mortality was reported as significant in later studies . However, several studies did not report significant association between CKD and risk of mortality in TAVR patients .…”

Section: Discussionmentioning

confidence: 96%

“…The association between stage 4 or 5 CKD and increased mortality was reported as significant in later studies. 19,20,[25][26][27][28] However, several studies did not report significant association between CKD and risk of mortality in TAVR patients. [29][30][31] Our meta-analysis demonstrated the association between CKD and 30-day overall mortality, 30-day cardiovascular mortality, long-term cardiovascular mortality, and long-term overall mortality.…”

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta‐analysis

Rattanawong

Kanitsoraphan

Kewcharoen

et al. 2019

Cathet Cardio Intervent

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Objective We performed a systematic review and meta‐analysis to explore the association between chronic kidney disease (CKD) and mortality and procedural complications in transcatheter aortic valve replacement (TAVR). Background The impact of varying stages of CKD or end‐stage renal disease (ESRD) on patients receiving TAVR is not clearly identified. Methods We searched the databases of MEDLINE and EMBASE from inception to May 2018. Included studies were published TAVR studies that compared the risk of mortality and procedural complications in CKD patients compared to control patients. Data from each study were combined using the random‐effects model. Results Twelve studies (42,703 CKD patients and 51,347 controls) were included. Compared with controls, CKD patients had a significantly higher risk of 30‐day overall mortality (risk ratio [RR] = 1.56, 95% confidence interval [CI]: 1.34–1.80, I2 = 60.9), long‐term cardiovascular mortality (RR = 1.44, 95% CI: 1.22–1.70, I2 = 36.2%), and long‐term overall mortality (RR = 1.66, 95% CI: 1.45–1.91, I2 = 80.3), as well as procedural complications including pacemaker requirement (RR = 1.20, 95% CI: 1.03–1.39, I2 = 56.1%) and bleeding (RR = 1.60, 95% CI: 1.26–2.02, I2 = 86.0%). Risk of mortality and procedural complications increased with severity of CKD for stages 3, 4, and 5, respectively, in terms of long‐term overall mortality (RR = 1.28, 1.82, and 2.12), 30‐day overall mortality (RR = 1.26, 1.89, and 1.93), 30‐day cardiovascular mortality (RR = 1.18, 1.75, and 2.50), and 30‐day overall bleeding (RR = 1.19, 1.63, and 2.12). Conclusions Our meta‐analysis demonstrates a significant increased risk of mortality and procedural complications in patients with CKD who underwent TAVR compared to controls.

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“…Especially in combination with other cardiovascular risk factors, CKD might render AF patients ineligible for long-term OAC and might favour LAAC in many of these patients. However, renal failure was also shown to increase the rate of periprocedural complications in cardiac interventions and to worsen the outcome [10,11]. Currently, outcome data on LAAC in CKD patients are limited [12].…”

Section: Introductionmentioning

confidence: 99%

Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE registry

et al. 2020

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Objectives Chronic kidney disease (CKD) is associated with an increased complication rate after cardiac interventions. Although CKD has a high prevalence among atrial fibrillation patients, the impact of CKD on periprocedural complications and the outcome after an interventional left atrial appendage closure (LAAC) is unclear. The present study, therefore, aimed to investigate whether CKD influences the procedure's effectiveness and safety. Methods LAARGE is a prospective, non-randomised registry. LAAC was conducted with different standard commercial devices, and the follow-up period was one year. CKD was defined by an eGFR < 60 mL/min/1.73 m 2 , and subgroups were further analysed (i.e. eGFR < 15, 15-29, and 30-59 mL/min/1.73 m 2 , respectively). Results Two hundred ninety-nine of 623 patients (48.0%) revealed a CKD. The prevalence of cardiovascular comorbidity, CHA 2 DS 2 -VASc score (4.9 vs. 4.2), and HAS-BLED score (4.3 vs. 3.5) was significantly higher in CKD patients (each p < 0.001). Implantation success was similarly high across all GFR groups (97.9%). Periprocedural MACCE (0.7 vs. 0.3%), and other major complications (4.7 vs. 3.7%) were comparably infrequent. Survival free of stroke was significantly lower among CKD patients within 1 year (82.0 vs. 93.0%; p < 0.001; consistent after adjustment for confounding factors), without significant accentuation in advanced CKD (i.e. eGFR < 30 mL/min/1.73 m 2 ; p > 0.05 vs. eGFR 30-59 mL/min/1.73 m 2 ). Non-fatal strokes were absolutely infrequent during follow-up (0 vs. 1.1%). Severe non-fatal bleedings were observed only among CKD patients (1.4 vs. 0%; p = 0.021). Conclusions Despite an increased cardiovascular risk profile of CKD patients, device implantation was safe, and LAAC was associated with effective stroke prevention across all CKD stages.

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

Abstract: 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.

Cited by 118 publications

References 24 publications

In‐hospital outcome of peripheral vascular intervention in dialysis‐dependent end‐stage renal disease patients

In‐hospital outcome of peripheral vascular intervention in dialysis‐dependent end‐stage renal disease patients

Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta‐analysis

Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE registry

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