Mean Transaortic Gradient is an Emerging Predictor of Chronic Kidney Disease in Elderly Patients

Abstract

Arterial hypertension (AH) is a major risk factor for chronic kidney disease (CKD). However, whether AH maintains this role in the development of CKD in elderly patients with aortic stenosis (AS) or whether transaortic gradient influences CKD remains unclear. Consecutive hospitalized patients were prospectively recruited to evaluate the relationship between AS and CKD. In all patients, transthoracic 2-dimensional echocardiography was performed to evaluate AS; renal function was evaluated using the Chronic Kidney Disease Epidemiology Collaboration formula. A total of 346 patients were included in the study (mean age: 79.5 ± 7.4 years): 104 had diabetes mellitus (DM), 298 had AH, and 59 (moderate: 52; severe: 7) showed AS. After multivariate analysis, age ( P <.01), DM ( P = .02), and mean transaortic gradient ( P = .03), but not AH, were independent predictors of CKD. Both in the presence (n = 59) or absence (n = 287) of AS, the estimated glomerular filtration rate did not differ in patients with (51 ± 24 mL/min/1.73 m and 59 ± 25 mL/min/1.73 m, respectively) and those without AH (50 ± 21 mL/min/1.73 m and 65 ± 24 mL/min/1.73 m, respectively). In the whole population, for each mm Hg of mean transaortic gradient, the risk of CKD increased by 2.5 times.

Positive blood pressure response may predict the recovery of renal function after transcatheter aortic valve implantation

“…Age, HT, diabetes mellitus, CAD, and peripheral artery disease are all contributing factors to presence of renal impairment in AS patients. Beyond co-morbid facilitating factors, CKD itself may cause AS by promoting calcium accumulation in the aortic valve [26,27].…”

“…In addition, the eGFR increase at 48 h and positive BP response were the other independent predictors of IRF at the 1st month. Theoretically, decreased cardiac output owing to the AS may lead to reduced renal perfusion [27]. Moreover, increased renal venous pressure due to congestive heart failure accompanied by severe AS was thought to be one of the underlying mechanisms of renal impairment.…”

Valvular Heart Disease in Patients with Chronic Kidney Disease

“…Calcific AS is the most prevalent VHD among patients with ESRD. [ 8 , 13 , 26 ] Mitral stenosis in this population typically includes severe MAC (mostly of the posterior mitral annulus) and thickening of the base of the mitral leaflets, whereas the leaflet tips and commissures are usually less affected. [ 27 ] For this reason, the incidental finding of MAC in the echocardiogram of a younger adult should arouse suspicion and should be investigated further.…”

“…[ 11 – 13 ] Severe AS is also highly prevalent in ESRD patients compared with the general population, in which the prevalence of severe AS is approximately 3% in individuals aged >75 years, with prevalence increasing with age. [ 13 , 23 , 24 , 26 ]…”

“…One possible explanation is that longstanding AS impairs forward blood flow from the heart, which, in turn, causes hypoperfusion of the kidneys, leading to CKD. [ 26 , 33 ] For this reason, renal dysfunction may be the ‘first symptom’ observed in patients with severe AS. [ 34 , 35 ] The prevalence of preoperative advanced CKD, namely GFR <30 ml/min/1.73 m 2 , is 11.5% in patients with severe MR receiving a MitraClip.…”