Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement
Open Access
- 20 October 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Heart Association
- Vol. 9 (19)
- https://doi.org/10.1161/JAHA.120.017190
Abstract
Background The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic-valve replacement (AVR) versus conservative management on long-term mortality by stage of CKD. Methods and Results We included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate: no CKD, mild CKD, moderate CKD, and severe CKD. The 5-year survival rate was 71 +/- 1% for patients without CKD, 62 +/- 2% for those with mild CKD, 54 +/- 3% for those with moderate CKD, and 34 +/- 4% for those with severe CKD (P<0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all-cause (hazard ratio [HR] [95% CI]=1.36 [1.08-1.71];P=0.009 and HR [95% CI]=2.16 [1.67-2.79];P<0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03-1.88];P=0.031 and HR [95% CI]=1.69 [1.18-2.41];P=0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (P=0.002) and severe CKD (P<0.001). AVR was associated with a marked reduction in all-cause and cardiovascular mortality versus conservative management for each CKD group (allP<0.001). The joint-test showed no interaction between AVR and CKD stages (P=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (allP<0.0017). Conclusions In severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all-cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR.This publication has 30 references indexed in Scilit:
- Prognostic score–based balance measures can be a useful diagnostic for propensity score methods in comparative effectiveness researchJournal of Clinical Epidemiology, 2013
- The performance of different propensity score methods for estimating marginal hazard ratiosStatistics in Medicine, 2012
- The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference reportKidney International, 2011
- Impact of Preoperative Renal Dysfunction on Long-Term Survival for Patients Undergoing Aortic Valve ReplacementThe Annals of Thoracic Surgery, 2011
- Prevalence of Chronic Kidney Disease in the United StatesJAMA, 2007
- Chronic Kidney DiseaseCirculation, 2007
- Outcome of 622 Adults With Asymptomatic, Hemodynamically Significant Aortic Stenosis During Prolonged Follow-UpCirculation, 2005
- Human Aortic Valve Calcification Is Associated With an Osteoblast PhenotypeCirculation, 2003
- AORTIC AND MITRAL VALVE CALCIFICATION IN PATIENTS WITH END-STAGE RENAL DISEASEThe Lancet, 1987
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987