Certain patients with chronic kidney disease face a higher risk of death after TAVR

Patients with chronic kidney disease (CKD) undergoing transcatheter aortic valve replacement (TAVR) may face a higher risk of death if they present with atrial fibrillation (AFib) or mitral stenosis (MS), according to a new study published in the American Journal of Cardiology.

“TAVR is generally considered a higher risk intervention in patients with kidney disease,” wrote Joshua Hahn, MD, a cardiologist at Baylor College of Medicine, and colleagues. “More data regarding the risk stratification of these patients are needed to guide real-world decision making.”

Hahn et al. explored data from the Mount Sinai Health System, focusing on 643 patients with CKD and 84 patients with end-stage kidney disease (ESKD) who underwent TAVR from 2011 to 2019.

The overall mortality for CKD patients undergoing TAVR was 5.1%. These patients were more likely to be white, the authors noted, and they presented with notably low rates of hypertension, diabetes, hyperlipidemia and obesity. Both AFib and MS were independently associated with a higher risk of TAVR mortality, even after making certain adjustments.  

The overall mortality for ESKD patients, meanwhile, was 11.9%. These patients were more likely to be white, just like the CKD cohort, and they presented with rates of hypertension, diabetes, hyperlipidemia and obesity that fell below 3%. In this case, however, “there were no statistically significant mortality associations observed, including between MS and mortality.”

“Not unlike previous database studies, we observed a significant mortality rate in patients undergoing TAVR with CKD and ESKD,” the authors wrote. “The exact interplay between renal dysfunction and aortic stenosis (AS) progression has not been clearly defined; however, there is an established relation between worsening renal function and progression of AS and adverse clinical outcomes observed in previous studies.”

The team did note that “the exact mechanism of AFib worsening TAVR outcomes” is still not fully understood. However, they said, “possible explanations include increased thromboembolic events and increased atrial pressures.” Also, “AFib may represent a surrogate marker of a more globally advanced cardiovascular disease state.”

Read the team’s full analysis here.

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