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Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve Replacement.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2017 Oct 23; Vol. 10 (20), pp. 2050-2060. - Publication Year :
- 2017
-
Abstract
- Objectives: This study sought to determine the association of chronic kidney disease (CKD) with in-hospital outcomes of transcatheter aortic valve replacement (TAVR).<br />Background: CKD is a known independent risk factor for worse outcomes after surgical aortic valve replacement (SAVR). However, data on outcomes of patients with CKD undergoing TAVR are limited, especially in those on chronic dialysis.<br />Methods: The authors used data from the 2012 to 2014 National Inpatient Sample database to identify all patients ≥18 years of age who underwent TAVR. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with no CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on long-term dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes.<br />Results: Of 41,025 patients undergoing TAVR from 2012 to 2014, 25,585 (62.4%) had no CKD, 13,750 (33.5%) had CKD, and 1,690 (4.1%) had ESRD. Compared with patients with no CKD, in-hospital mortality was significantly higher in patients with CKD or ESRD (3.8% vs. 4.5% vs. 8.3%; adjusted odds ratio [no CKD as reference]: 1.39 [95% confidence interval: 1.24 to 1.55] for CKD and 2.58 [95% confidence interval: 2.09 to 3.13] for ESRD). Patients with CKD or ESRD had a higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke), net adverse cardiovascular events (composite of major adverse cardiovascular events, major bleeding, or vascular complications), and pacemaker implantation compared with patients without CKD. Acute kidney injury (AKI) and AKI requiring dialysis were associated with several-fold higher risk-adjusted in-hospital mortality in patients in the no CKD and CKD groups. Moreover, the incidence of AKI and AKI requiring dialysis did not decline during the study period.<br />Conclusions: Patients with CKD or ESRD have worse in-hospital outcomes after TAVR. AKI is associated with higher in-hospital mortality in patients undergoing TAVR and the incidence of AKI has not declined over the years.<br /> (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Kidney Injury mortality
Acute Kidney Injury physiopathology
Acute Kidney Injury therapy
Aged
Aged, 80 and over
Aortic Valve diagnostic imaging
Aortic Valve physiopathology
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
Chi-Square Distribution
Databases, Factual
Female
Hospital Mortality
Humans
Incidence
Kidney Failure, Chronic diagnosis
Kidney Failure, Chronic mortality
Kidney Failure, Chronic therapy
Linear Models
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Renal Dialysis
Renal Insufficiency, Chronic diagnosis
Renal Insufficiency, Chronic mortality
Renal Insufficiency, Chronic therapy
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
United States epidemiology
Aortic Valve surgery
Aortic Valve Stenosis surgery
Kidney physiopathology
Kidney Failure, Chronic physiopathology
Renal Insufficiency, Chronic physiopathology
Transcatheter Aortic Valve Replacement adverse effects
Transcatheter Aortic Valve Replacement mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 10
- Issue :
- 20
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 29050621
- Full Text :
- https://doi.org/10.1016/j.jcin.2017.07.044