Kidney Function Change after Transcatheter Aortic Valve Replacement in Patients with Diabetes and/or Hypertension

Abstract

Background The kidney function change after Transcatheter Aortic Valve Replacement (TAVR) in diabetes and/or hypertension patients is currently unknown. Methods A total of 242 severe Aortic Stenosis patients with diabetes mellitus and/or hypertension who underwent TAVR were analyzed. Patients were categorized into 3 groups based on the percent change [(discharge eGFR – baseline eGFR) x 100/baseline eGFR] in eGFR: improved ≥ 10%, no change, and declined ≥ 10%. Results Of these patients, 93 (38.4%) had an improvement in eGFR ≥ 10%, 117 (48.3%) had no changes, and 32 (13.2%) had a decline in eGFR of more than 10%. Patients with unchanged kidney function may be with lower STS scores (5.09 [3.58–8.34] % vs. 7.04 [4.52–9.91] % vs. 7.41 [3.52–10.97] %, p = 0.003), and lower perivascular disease (14.5% vs. 26.9% vs. 40.6%, p = 0.003) when compared with improved and declined kidney function patients, respectively. Patients with improved kidney function had lower eGFR (45.0 [33.9–60.3] mL/min/1.73 m2 vs. 57.4 [43.4–70.7] mL/min/1.73 m2 vs. 56.6 [44.2–76.8] mL/min/1.73 m2, p = 0.000), and lower LVEF (55.1 [40.9–62.0] % vs. 60.4 [53.4–66.1] % vs. 59.9 [52.9–67.8] %, p = 0.002) than the unchanged or declined group, respectively. Moreover, patients with worsening kidney function had higher rate of in-hospital (12.5% vs. 1.7% vs. 0%, p = 0.002) and 30-day (15.6% vs. 1.7% vs. 0%, p = 0.000) mortality. Independent predictors of eGFR changes were STS scores, LVEF, baseline eGFR, and unplanned cardiopulmonary bypass. Conclusions Nearly 40% of diabetic and/or hypertensive patients experience an intermediate improvement after TAVR. Patients with declining renal function suffer more terrible outcomes in mortality.

Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study

“…In addition, those who developed a stable or improved renal function after TAVR had favourable survival rates at 2-year follow-up 9 . A further analysis revealed a higher improvement in kidney function in patients with lower ejection fraction, primarily due to afterload relief and kidney reperfusion 20 . In addition, patients with lower eGFR were more likely to develop improvements in renal function 21 .…”

“…On a positive note, compelling evidence supports the role of TAVR in improving the progression renal impairment in CKD patients. In an analysis of 410 patients, those with baseline CKD sustained higher rates of improvements in renal function after TAVR 20 . In addition, those who developed a stable or improved renal function after TAVR had favourable survival rates at 2-year follow-up 9 .…”