CKD Severity Influences Post-TAVR Outcomes
Worse kidney function before transcatheter aortic valve replacement (TAVR) is associated with a greater likelihood of renal replacement therapy (RRT) in patients with chronic kidney disease, according to a recent study.
Reported rates of RRT following TAVR have varied greatly. In order to explore this issue, researchers conducted a study in which they compared rates of death, new RRT, and a composite of both as a function of preprocedure glomerular filtration rate (GFR) using data from patients from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry.
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Overall, Preprocedure GFR was associated with the risk of death and new RRT after TAVR when GFR was <60 ml/min/m2, and increased significantly when GFR fell below 30 ml/min/m2. Incremental increases in GFR of 5 60 ml/min/m2 were statistically significant at 30 days, and continued to be at 1 year when preprocedure GFR was <60 ml/min/m2.
In stage 5 CKD patients, over 33% would require RRT within 30 days, and nearly 66% would require RRT at 1 year.
“In both unadjusted and adjusted analysis, pre-procedural GFR was associated with the outcomes of death and new RRT. Increasing CKD stage leads to an increased risk of death and/or RRT. Continuous analysis showed significant differences in outcomes in all levels of CKD when GFR was <60 ml/min/m2. Pre-procedure GFR should be considered when selecting CKD patients for TAVR.”
—Michael Potts
Reference:
Hansen JW, Foy A, Yadav P, et al. Death and dialysis after transcatheter aortic valve replacement. JACC. 2017;10(20).