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Change in Kidney Function and 2-Year Mortality After TAVR
Quick Takes
- More than 80% of patients showed stable or improved kidney function 1 month after TAVR.
- Improvement in kidney function had a favorable association with 2-year mortality, whereas deterioration in kidney function was associated with increased mortality regardless of baseline CKD status.
- These data underscore the importance of deterioration in kidney function after TAVR, either periprocedural or at steady state, and stress the need to prevent kidney injury in patients undergoing TAVR regardless of baseline renal function.
Study Questions:
What are the changes in kidney function (both periprocedural and at steady state) after transcatheter aortic valve replacement (TAVR) and the association with midterm mortality?
Methods:
The investigators conducted a single-center, retrospective cohort study at a public tertiary academic medical center, which serves as a regional referral center for valvular heart interventions. Consecutive cases of patients undergoing TAVR from November 5, 2008, to December 31, 2019, were included in the study, with available baseline and post-TAVR data on kidney function. Steady state (1 month) change in kidney function after TAVR was assessed. Significant improvement or deterioration in renal function was defined as ≥10% change in estimated glomerular filtration rate (eGFR). The main outcome measure was overall mortality at 2-year follow-up.
Results:
A total of 894 patients (mean [SD] age, 82.2 [7.1] years; 452 women [51.2%]) were evaluated. A total of 362 patients (40.5%) were treated from 2017-2019, 348 patients (38.9%) were treated from 2013-2016, and 184 patients (20.5%) were treated from 2008-2012. Patients had a mean (SD) Society of Thoracic Surgeons (STS) score of 5.2% (4.0%) and a mean (SD) eGFR of 65.1 (23.1) ml/min/1.73 m2. Acute kidney injury occurred in 115 (11.1%) patients by 48 hours, of whom 73 (63.5%) resolved by discharge. One month after TAVR, eGFR improved by ≥10% in 329 patients (36.8%) and deteriorated by ≥10% in 233 patients (26.1%). Overall, CKD stage remained stable or improved in 720 patients (80.6%), and only five patients (0.97%) progressed to stage 5 CKD 1 month after TAVR. A deterioration of ≥10% in eGFR 1 month after TAVR was associated with a hazard ratio of 2.16 (95% confidence interval, 1.24-5.24; p = 0.04) at 2-year mortality. Patients who showed CKD status resolution (eGFR improvement to >60 ml/min/1.73 m2 after TAVR) had a similar 2-year mortality to those with baseline eGFR >60 ml/min/1.73 m2 and vice versa. Factors associated with steady state CKD status resolution after TAVR included lower STS score, higher left ventricular ejection fraction, higher baseline eGFR, no acute kidney injury at discharge from the TAVR admission, and lower contrast-eGFR ratio.
Conclusions:
The authors concluded that kidney outcomes after TAVR were reassuring with >80% of patients showing stable or improved kidney function 1 month after the procedure.
Perspective:
This study reports that >80% of patients show stable or improved kidney function 1 month after TAVR. Furthermore, improvement in kidney function had a favorable association with 2-year mortality, whereas deterioration in kidney function was associated with increased mortality regardless of baseline CKD status. Overall, these data provide reassurance regarding safety of TAVR in terms of kidney outcomes, both in the overall population as well as in those with aortic stenosis (AS) and CKD. These data also underscore the importance of deterioration in kidney function after TAVR and stress the need to prevent kidney injury in patients undergoing TAVR regardless of baseline renal function. Future studies need to identify the role of cardiorenal syndrome as a main cause of CKD in the AS population in order to improve patient selection and optimize outcomes after TAVR.
Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Chronic Heart Failure, Interventions and Structural Heart Disease
Keywords: Academic Medical Centers, Acute Kidney Injury, Aortic Valve Stenosis, Cardio-Renal Syndrome, Geriatrics, Glomerular Filtration Rate, Heart Valve Diseases, Kidney Diseases, Metabolic Syndrome, Outcome Assessment, Health Care, Patient Discharge, Primary Prevention, Renal Insufficiency, Chronic, Stroke Volume, Transcatheter Aortic Valve Replacement, Ventricular Function, Left
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