Chronic kidney disease confers worse outcomes in transcatheter mitral valve repair
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In transcatheter mitral valve repair, patients with chronic kidney disease or end-stage renal disease experienced worse outcomes and more 30-day readmission compared with patients without chronic kidney disease, researchers reported.
It was also noted that some patients who were readmitted after transcatheter mitral valve repair (TMVR) showed improvements in renal function.
“Chronic kidney disease has been shown to be associated with poor outcomes in surgical and transcatheter valve interventions,” Khalid Sawalha, MD, resident in internal medicine at University of Massachusetts Medical School–Baystate Medical Center in Springfield, and colleagues wrote. “Since the prevalence of chronic kidney disease in trials evaluating patients undergoing mitral valve repair was as high as 23% in EVEREST II High-Risk Study, 40% in ACCESS-EU, and 71% in the COAPT trial, it was important to evaluate the outcomes in chronic kidney disease patients and compare them with patients without chronic kidney disease.”
For the study, published in Catheterization and Cardiovascular Interventions, investigators utilized the 2016 National Readmission Database to evaluate 4,645 patients (mean age, 79 years) who underwent transcatheter mitral valve repair. Patients were then classified as having chronic kidney disease (CKD), end-stage renal disease (ESRD) or no CKD. Primary outcomes were in-hospital mortality, 30- and 90-day readmission rate and change in CKD status upon readmission.
In-hospital mortality, readmission rate
Researchers observed that in-hospital mortality was significantly higher among patients with CKD (OR = 2.01; 95% CI, 1.27-3.18) and those with ESRD (OR = 6.38; 95% CI, 1.49-27.36) compared with the non-CKD group.
Although 30-day readmission was not significantly different between patients with CKD and those without (OR = 1.25; 95% CI, 0.97-1.62), readmission was more frequent among patients with ESRD compared with the non-CKD group (OR = 2.24; 95% CI, 1.3-3.87).
Additionally, there was no observable difference in 90-day readmission between the non-CKD group and the patients with CKD (OR = 1.25; 95% CI, 1-1.58), but was significantly more frequent among patients with ESRD than in those without CKD (OR = 2.51; 95% CI, 1.7-3.72).
Moreover, patients with CKD developed acute kidney injury (OR = 4.15; 95% CI, 3.02-5.69) and cardiogenic shock (OR = 1.99; 95% CI, 1.14-3.46) more often compared with the non-CKD group.
Acute respiratory failure was significantly more prevalent among patients with ESRD (OR = 10.37; 95% CI, 1.52-70.77) compared with the non-CKD group, but there was no difference between the non-CKD group and the patients with CKD (OR = 4.49; 95% CI, 0.82-6.49).
“We noted that these patients are at higher risk of cardiogenic shock and acute respiratory failure, which may have contributed to mortality,” the researchers wrote. “In addition, the percent of patients with medical comorbidities increased as the kidney dysfunction increased. For example, anemia is a known independent predictor of mortality in renal disease patients who undergo TMVR and prevalence in our study was higher in ESRD group compared to patients with CKD (42% vs. 20%).”
Changes in kidney function
In other findings, among patients with CKD who were readmitted within 30 days, 30.1% showed improvement in kidney function, 65.8% showed no change and 4.1% showed a decrease in kidney function compared with their index visit.
Among patients in the non-CKD group readmitted within 30 days, 80.7% maintained their kidney function at readmission while 19.3% showed decreased kidney function.
Kidney function did not change among patients with ESRD at 30-day readmission compared with their index visit.
Among patients with CKD who were readmitted within 90 days, 31.4% showed improvements in kidney function, 57.6% showed no change and 11% showed a decrease in function, compared with their index visit.
In the non-CKD group, 83.5% maintained their kidney function at readmission within 90 days while 16.5% experienced a decrease, according to the study.
Among patients with ESRD readmitted within 90 days, 10.8% experienced an increase in kidney function compared with their index visit.
“In our study, improvement in kidney function was seen earlier during the 30-day readmission,” the researchers wrote. “Similarly, we noted improvement in kidney function at 90 days amongst those who were readmitted. While we assume that this may be secondary to the improvement in mitral regurgitation, there is no way for us to evaluate if this was true due to lack of echocardiographic data in the National Readmission Database data set. One interesting point that we found in our data was that several patients in the ESRD group had an improvement in kidney function.”
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