Kidney outcomes stable or improved in most patients after TAVR
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More than 80% of patients who underwent transcatheter aortic valve replacement experienced stable or improved kidney outcomes 1 month after the procedure, researchers reported.
“Transcatheter aortic valve replacement is now established as the preferred treatment for older adults with severe aortic stenosis who are at intermediate or higher surgical risk,” Guy Witberg, MD, from the department of cardiology at Rabin Medical Center-Beilinson Hospital in Petach Tikva, Israel, and colleagues wrote in JAMA Network Open. “We previously reported that for patients with moderate or worse chronic kidney disease who suffer from aortic stenosis, TAVR is associated with a stabilization of kidney function, whereas conservative treatment is associated with deterioration in kidney function.”
The single-center, retrospective cohort study included 894 consecutive patients (mean age, 82 years; 51% women) undergoing TAVR from November 2008 to December 2019. All patients had available baseline and post-TAVR kidney function data.
The primary outcome was overall mortality at 2 years.
In total, 40.5% of patients were treated from 2017 to 2019, 38.9% were treated from 2013 to 2016 and 20.5% were treated from 2008 to 2012. The mean Society of Thoracic Surgeons score was 5.2% and mean estimated glomerular filtration rate (eGFR) was 65.1 mL/min/1.73 m2 in the cohort.
Researchers observed acute kidney injury among 11.1% of patients 48 hours after TAVR with 63.5% of these patients resolving by discharge. There was an improvement in eGFR of at least 10% in 36.8% of patients, and there was a deterioration of at least 10% in 26.1% of patients in the month after the procedure.
Most stable or improved
Among 80.6% of patients, chronic kidney disease (CKD) stage remained stable or improved and only 0.97% of patients progressed to stage 5 CKD a month after their TAVR procedure.
Deterioration of eGFR of at least 10% 1 month after the procedure was associated with 2-year mortality (HR = 2.16; 95% CI, 1.24-5.24; P = .04). Those who resolved their CKD status demonstrated a similar 2-year mortality to patients with a baseline eGFR of greater than 60 mL/min/1.73 m2 (HR = 0.92; 95% CI, 0.51-1.66; P = .79).
Researchers noted lower STS score, higher left ventricular ejection fraction, higher baseline eGFR, no acute kidney injury at discharge after TAVR procedure and lower contract eGFR ratio as factors that were associated with steady CKD status resolution after TAVR.
“Future studies should focus on identifying the role of cardiorenal syndrome as a main cause of CKD in the aortic stenosis population in order to improve patient selection and optimize outcomes after TAVR,” the researchers wrote.
TAVR and cardiorenal syndrome
In an accompanying editorial, Benjamin Z. Galper, MD, MPH, physician in the department of cardiology and director of the structural heart disease program at the Mid-Atlantic Permanente Medical Group in McLean, Virginia, noted that the study highlights the potential for TAVR in cardiorenal syndrome and the urgent need for preventing acute kidney injury and worsening CKD after the procedure.
“While female sex is more likely to be associated with cardiorenal syndrome, we must invest in efforts to better determine risk factors and diagnostic criteria, including biomarkers, to be able to detect cardiorenal syndrome at earlier stages in patients with aortic stenosis,” Galper wrote. “Through early detection and treatment, perhaps we will be able to simultaneously treat both the heart and the kidney with TAVR and realize even better outcomes in patients with CKD undergoing TAVR.”
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