TAVR’s renal benefits may outweigh mortality risk for some patients with CKD
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Key takeaways:
- TAVR may improve kidney function for more patients than it worsens in low-flow, low-gradient aortic stenosis.
- Chronic kidney disease is tied to higher mortality after TAVR, so patients must be closely followed.
In adults with chronic kidney disease and low-flow, low-gradient aortic stenosis, transcatheter aortic valve replacement improved kidney function for more patients than it worsened, data show.
“It is important to look at TAVR outcomes in patients with chronic kidney disease (CKD) because TAVR is the standard of care in patients with aortic stenosis who have elevated surgical risk,” Ankur Dalsania, MD, an internal medicine resident at the Icahn School of Medicine at Mount Sinai, told Healio. “Many of these patients with elevated risk have CKD, so it is important to study the relationship between CKD and TAVR outcomes so providers and patients can make better informed decisions. Additionally, low-flow, low-gradient aortic stenosis comprises up to 30% of all aortic stenosis cases, so it is valuable to know how CKD affects TAVR outcomes in this particular subset.”
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In a retrospective, single-center study, Dalsania and colleagues analyzed data from 344 patients with low-flow, low-gradient severe aortic stenosis who underwent TAVR from 2019 to 2021. Researchers stratified patients by estimated glomerular filtration rate of 60 mL/min/1.73 m2 or greater or less than 60 mL/min/1.73 m2 before the TAVR procedure. The primary outcome was all-cause mortality. Secondary outcomes included HF hospitalization and change in CKD stage at 30 days after TAVR.
The findings were published in the American Journal of Cardiology.
Within the cohort, 42.7% had CKD and 14.3% of those with CKD had end-stage renal disease. Median follow-up was 367 days.
The primary outcome of all-cause mortality occurred in 6.6% patients without CKD and in 25.2% of patients with CKD, for an HR of 4.19 (95% CI, 2.22-7.88).
After adjustment, the presence of CKD was most strongly associated with an increase in all-cause mortality (HR = 3.89; 95% CI, 2.03-7.47). The presence of CKD did not affect HF hospitalization.
Among patients with CKD but without end-stage renal disease, 23.8% experienced an improvement in CKD stage at 30 days, 50% had no change and 11.1% had worsening of CKD stage.
“The takeaway here is the added risk for TAVR needs to be weighed by not only cardiovascular benefits but also renal benefits,” Dalsania told Healio. “This makes sense as TAVR likely improves forward flow and relieves congestion, both of which would improve kidney function, so it is reassuring that the data supports that reasoning.”
The researchers noted that clinicians should follow patients with CKD closely after TAVR to monitor for any adverse outcomes.
“TAVR should be considered when appropriate in patients with CKD and low-flow aortic stenosis despite being at a higher risk for adverse events because of the CKD,” Stamatios Lerakis, MD, PhD, professor of medicine (cardiology) at the Icahn School of Medicine at Mount Sinai, told Healio. “TAVR can also provide renal function improvement in these patients. Larger studies are needed to provide more definite conclusions on this high-risk group of patients.”
For more information:
Stamatios Lerakis, MD, PhD, can be reached at stamatios.lerakis@mountsinai.org.
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