2022 Volume 4 Issue 1 Pages 23-34
Objective: Chronic kidney disease (CKD) increases the risk of cardiorenal (CR) events such as progression leading to regular hemodialysis, rehospitalization for heart failure (re-HF), and death from cardiac or renal cause (CR death). This study aimed to assess the rates of late adverse CR events among patients with CKD following transcatheter aortic valve replacement (TAVR).
Methods: Data of 2588 patients who underwent TAVR were extracted from the Japanese multicenter registry. The rates of progression leading to regular hemodialysis, re-HF in 1 year, predictive value of re-HF within 1 year, and mortality were assessed according to each CKD category divided into stages 1+2, 3a, 3b, 4, and 5. The advanced CKD was defined as CKD stage ≥3b.
Results: The incidences of hemodialysis after TAVR (n = 20) were increased across the CKD stages (0%, 0.13%, 0.58%, 2.17%, and 20.9%, respectively, p <0.001) and rates of re-HF within 1 year (n = 162) were significantly increased across the CKD stages (3.3%, 5.2%, 8.2%, 10.9%, and 17.0%, respectively, p <0.001). The Cox regression multivariable analysis revealed that the advanced CKD was the independent factor for predicting re-HF within 1 year after TAVR (all p <0.05). The Cox regression multivariable analysis demonstrated that the advanced CKD significantly increased the risk of all-cause death and CR death after TAVR (all p <0.05). The landmark analysis beyond 1 year after TAVR showed similar mortality rates between the patients with non-advanced CKD with re-HF within 1 year and those with advanced CKD without re-HF within 1 year (p = 0.74).
Conclusion: The re-HF and subsequent mortality increase in 1 year as the late CR events after TAVR were significantly increased across the CKD stages. Careful preventative management of re-HF is necessary after TAVR in patients with CKD, especially in the advanced CKD patients.