Impact of Transcatheter Aortic Valve Replacement on Severity of Chronic Kidney Disease

Cubeddu, Robert J.; Asher, Craig R.; Lowry, Ashley M.; Blackstone, Eugene H.; Kapadia, Samir; Alu, Maria; Thourani, Vinod H.; Mack, Michael J.; Kodali, Susheel; Herrmann, Howard C.; Forcillo, Jessica; Babaliaros, Vasilis; Devireddy, Chandan; Malaisrie, S. Chris; Davidson, Charles J.; Jaber, Wael A.; Leon, Martin B.; Svensson, Lars G.

doi:10.1016/j.jacc.2020.07.048

Cited by 48 publications

(52 citation statements)

References 24 publications

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“…Author affiliations and article information are listed at the end of this article. patients with low or intermediate risk of surgical AVR, 89% of patients with CKD demonstrated a stabilization or improvement in CKD stage after TAVR, 6 which is similar to the analysis of patients with low or intermediate risk in the study by Witberg et al 3 These findings validate the conclusions of prior randomized clinical trials in a nonrandomized, all-comers setting and suggest that TAVR can arrest cardiorenal syndrome and lead to long-term improved kidney function in patients with CKD.…”

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confidence: 80%

Can Transcatheter Aortic Valve Replacement Cure Cardiorenal Syndrome?

Galper¹

2021

JAMA Netw Open

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Cardiorenal syndrome can be challenging to diagnose, but the combination of heart failure and worsening kidney function portends a worse prognosis than either individual diagnosis. 1 Additionally, heart failure treatments, including diuretics and neurohormonal antagonists, frequently exacerbate chronic kidney disease (CKD), and the focus of increased hydration and limiting insults to the renal system in treating CKD leads to worsening heart failure. Therefore, cardiorenal syndrome is a vicious cycle, and the diagnosis that may contribute most to the interplay of worsening cardiorenal function is aortic stenosis (AS). Worsening kidney function leads to progressive AS, 2 and worsening severity of AS leads to decreased cardiac output, decreased kidney perfusion, and increased venous congestion, which leads to further deterioration in kidney function. 1 Therefore, given that AS is a progressive intertwined death spiral of both the heart and the kidney, it may be reasonable to posit that correcting AS through aortic valve replacement could improve kidney function and arrest, if not reverse, cardiorenal syndrome. While we would assume that transcatheter aortic valve replacement

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confidence: 80%

Can Transcatheter Aortic Valve Replacement Cure Cardiorenal Syndrome?

Galper¹

2021

JAMA Netw Open

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“…However, given the well‐known association between heart failure and kidney function (i.e., cardio‐renal syndrome), we cannot exclude that TAVR may benefit to the renal function by increasing cardiac output, normalizing sympathetic tone and enhancing diuresis with relief of venous congestion. Consistently, a recent pooled analysis of three randomized controlled trials showed that patients treated by TAVR had a steady or improved post‐procedural renal function, with less than 7% of progression to worse CKD stage during follow up (23% stage 1, 10% stage 2, 11% stage 3A, 6.2% stage 3B, and 0.82% stage 4, 0.035% stage 5) 3 . The latter, rather than those with lower eGFR at baseline, had an increased post‐procedural mortality both at early‐ and mid‐term follow up 3 …”

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confidence: 63%

“…Consistently, a recent pooled analysis of three randomized controlled trials showed that patients treated by TAVR had a steady or improved post‐procedural renal function, with less than 7% of progression to worse CKD stage during follow up (23% stage 1, 10% stage 2, 11% stage 3A, 6.2% stage 3B, and 0.82% stage 4, 0.035% stage 5) 3 . The latter, rather than those with lower eGFR at baseline, had an increased post‐procedural mortality both at early‐ and mid‐term follow up 3 …”

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confidence: 63%

“…In literature, conflicting results have been reported on the impact of TAVR in CKD patients. Although most of the studies reported increased in‐hospital and early mortality rates in patients with lower eGFR, 3 many confounders have to be taken into account, including use of iodine contrast and some specific TAVR‐related factors (i.e., reduced cardiac output during rapid pacing, arterial microembolization from crossing the aorta with the TAVR delivery system etc.). On the contrary, data on the interplay between TAVR and long term outcomes in patients with CKD are missing.…”

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confidence: 99%

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Transcatheter aortic valve replacement and chronic kidney disease: Close friends or sworn enemies?

Tarantini

Cardaioli

2021

Cathet Cardio Intervent

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Key Points Transcatheter aortic valve replacement (TAVR) has been associated with a lower incidence of post‐procedural acute renal failure than surgical aortic valve replacement (SAVR). Nonetheless, kidney injury still remains a relatively frequent complication after TAVR, leading to worse outcomes. The early outcomes after trans‐femoral TAVR, in patients with or without chronic kidney disease (CKD) are similar. At long‐term follow‐up, patients with advanced CKD trend to higher mortality, stroke and vascular complications.

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“…The optimal timing of the initiation of kidney replacement therapy in patients with acute kidney damage in intensive care medicine was investigated in two randomized studies, which are correspondingly discussed. [24,25]. Insgesamt 91 % der Teilnehmer hatten zum Untersuchungsbeginn eine eGFR von weniger als 90 ml/min/1,73 m 2 (KDIGO-GFR-Stadium < G2); periinterventionell wurden durchschnittlich 100 ml Kontrastmittel appliziert.…”

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Aktuelles zur Herz-Nieren-Interaktion

Emrich

Tokcan

Ghorani

et al. 2021

Herz

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ZusammenfassungChronisch nierenkranke Patienten weisen eine erhöhte kardiovaskuläre Morbidität und Sterblichkeit auf. Im letzten Jahr sind einige wichtige Studien zur Herz-Nieren-Interaktion veröffentlicht worden, die im Folgenden zusammengefasst und diskutiert werden. In der DAPA-CKD-Studie sowie in der SCORED-Studie konnten 2 unterschiedliche SGLT2(„sodium-glucose linked transporter 2“)-Inhibitoren (Dapagliflozin und Sotagliflozin) die Prognose von chronisch nierenkranken Patienten mit und ohne Diabetes nachweislich verbessern. Auch die Ergebnisse der randomisierten Studie zum neuen Mineralokortikoidrezeptorantagonisten Finerenon – FIDELIO-DKD – liefern einen vielversprechenden neuen Therapieansatz für Patienten mit diabetischer Nephropathie. Die veröffentlichten Daten der ISCHEMIA-CKD-Studie bei Patienten mit koronarer Herzkrankheit und Untersuchungen zum Einfluss einer TAVI („transcatheter aortic valve implantation“) auf die Nierenfunktion sowie eine weitere Studie zum akuten Nierenversagen nach MitraClip®-Implantation (Abbott, Chicago, IL, USA) geben wichtige Hinweise zu zukünftigen Handlungsempfehlungen. Der optimale Zeitpunkt der Einleitung einer Nierenersatztherapie bei Patienten mit akuter Nierenschädigung in der Intensivmedizin wurde in 2 randomisierten Studien untersucht, die entsprechend diskutiert werden.

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Impact of Transcatheter Aortic Valve Replacement on Severity of Chronic Kidney Disease

Cited by 48 publications

References 24 publications

Can Transcatheter Aortic Valve Replacement Cure Cardiorenal Syndrome?

Can Transcatheter Aortic Valve Replacement Cure Cardiorenal Syndrome?

Transcatheter aortic valve replacement and chronic kidney disease: Close friends or sworn enemies?

Aktuelles zur Herz-Nieren-Interaktion

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