Effect of advanced chronic kidney disease in clinical and echocardiographic outcomes of patients treated with MitraClip system

Estévez‐Loureiro, Rodrigo; Settergren, Magnus; Pighi, Michele; Winter, Reidar; Dall’Ara, Gianni; Jacobsen, Per; Søndergaard, Lars; Cheung, Gary Shun Pan; Ghione, Matteo; Ihlemann, Nikolaj; Moat, Neil; Price, Susanna; Rosenberg, Tine Streit; Mario, Carlo Di; Franzen, Olaf

doi:10.1016/j.ijcard.2015.06.137

Cited by 21 publications

(8 citation statements)

References 35 publications

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“…It should be noted that mild CKD was not independently associated with mortality. This finding is concordant with the recent study from another group [41].…”

Section: Discussionsupporting

confidence: 94%

Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip

Kaneko

Neuß

Schau

et al. 2017

Journal of Cardiology

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“…It should be noted that mild CKD was not independently associated with mortality. This finding is concordant with the recent study from another group [41].…”

Section: Discussionsupporting

confidence: 94%

Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip

Kaneko

Neuß

Schau

et al. 2017

Journal of Cardiology

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“…We could not classify CKD group into different stages of CKD. It is possible that severe CKD (eGFR <30) did worse than mild–moderate CKD as shown by Kaneko et al and Estevez‐Loureiro et al 21,36 Comorbidities were extracted based on ICD‐9‐clinical modification (CM) and ICD‐10 codes, and therefore severity of comorbidities could not be accounted for. Information on Society of Thoracic Surgeons scores and prognostic data such as left ventricular ejection fraction were not available.…”

Section: Discussionmentioning

confidence: 99%

Association of baseline kidney disease with outcomes of transcatheter mitral valve repair by MitraClip

Raheja

Ahuja

Nazir

et al. 2020

Cathet Cardio Intervent

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Objectives This study sought to determine the impact of baseline chronic kidney disease (CKD) on in‐hospital outcomes of transcatheter mitral valve repair with MitraClip (MC). Background MC is now an established treatment in high surgical risk patients. However, limited data are available on outcomes of MC in patients with baseline renal dysfunction. Methods The authors used data from January 2014 to December 2017 National Readmission Database to identify all patients ≥18 years of age who underwent MC. International classification of diseases (ICD)‐9 and ICD‐10 codes were used to identify patients with no‐CKD, CKD (without chronic dialysis), or end‐stage renal disease (ESRD) on dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in‐hospital outcomes. Results Of 13,563 patients undergoing MC, 8,935 (65.8%) had no‐CKD, 4,152 (30.6%) had CKD, and 476 (3.5%) had ESRD. ESRD patients compared to CKD and no‐CKD had significantly higher mortality (7.2% vs. 2.5% vs. 2.0%; p < .001), higher incidence of bleeding, blood transfusions, and 30 day all cause readmission. CKD patients compared to no‐CKD had significantly higher mortality (odds ratio‐1.29; CI 1.01–1.65; p = .04), acute kidney injury (odds ratio‐3.0; CI 2.69–3.34; p < .001), new in‐hospital hemodialysis (odds ratio‐ 2.70; CI 1.57–4.62; p < .001), blood transfusions, 30 day all cause and congestive heart failure (CHF) readmissions. In‐hospital stroke and cardiac tamponade did not differ between the three groups. Patients with baseline kidney disease undergoing MC had higher mortality at high volume centers compared to low volume centers. CHF was the most common cause of readmission postMC in patients with or without preprocedural kidney disease. Conclusion Patients with baseline kidney disease have worse outcomes after MC with higher readmission rates requiring careful patient selection and follow up in this population.

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“…To address this question, an analysis of a multicenter MitraClip registry involving 173 patients was undertaken which showed that those patients with advanced CKD [GFR<30 cc/min/1.73M 2 ] had an increased rate of mortality when compared to patients with GFR>30 mL/min/1.73 m 2 [HR=10, p=0.0 11 ]. It was also noted there was no difference in mortality between those with moderate CKD [GFR>30 but <60 cc/min/1.73M 2 ] and with no CKD at all [ 53 ]. There was also a trend towards improvement in NYHA functional class among those with CKD, although insignificant, which progressively narrowed down with advancement in CKD stage.…”

Section: Chronic Kidney Disease As a Predictor Of Poor Outcomes Post mentioning

confidence: 99%

Interrelationship Between Kidney Function and Percutaneous Mitral Valve Interventions: A Comprehensive Review

Dayanand

Ram

et al. 2019

CCR

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Percutaneous mitral valve repair is emerging as a reasonable alternative especially in those with an unfavorable surgical risk profile in the repair of mitral regurgitation. At this time, our understanding of the effects of underlying renal dysfunction on outcomes with percutaneous mitral valve repair and the effects of this procedure itself on renal function is evolving, as more data emerges in this field. The current evidence suggests that the correction of mitral regurgitation via percutaneous mitral valve repair is associated with some degree of improvement in cardiac function, hemodynamics and renal function. The improvement in renal function was more significant for those with greater renal dysfunction at baseline. The presence of Chronic Kidney Disease (CKD) in turn has been associated with poor long-term outcomes including increased mortality and hospitalization among patients who undergo percutaneous mitral valve repair. This was true regardless of the degree of improvement in GFR post repair advanced CKD. The adverse impact of CKD on long-term outcomes was consistent across all studies and was more prominent in those with GFR<30 mL/min/1.73 m². It is clear that from these contrasting evidences of improved renal function post mitral valve repair but poor long-term outcomes including increased mortality in patients with CKD, that proper patient selection for percutaneous mitral valve repair is key. There is a need to have better-standardized criteria for patients who should qualify to have percutaneous mitral valve replacement with Mitraclip. In this new era of percutaneous mitral valve repair, much work needs to be done to optimize long-term patient outcomes.

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Effect of advanced chronic kidney disease in clinical and echocardiographic outcomes of patients treated with MitraClip system

Cited by 21 publications

References 35 publications

Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip

Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip

Association of baseline kidney disease with outcomes of transcatheter mitral valve repair by MitraClip

Interrelationship Between Kidney Function and Percutaneous Mitral Valve Interventions: A Comprehensive Review

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