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Published on: August 8, 2025
Association of CKD with Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation
Florian Lüders1, Klaus Kaier2,3, Gerrit Kaleschke4
1Division of Vascular Medicine, Department of Cardiovascular Medicine and.
Insights
Chronic kidney disease (CKD) is linked to worse outcomes after transcatheter aortic valve implantation (TAVI), including higher mortality and bleeding risks. Early CKD staging is crucial for patient risk stratification before TAVI procedures.
Area of Science:
- Cardiology
- Nephrology
- Health Services Research
Background:
- Chronic kidney disease (CKD) is associated with poorer cardiovascular and overall prognoses.
- The impact of CKD on outcomes following transcatheter aortic valve implantation (TAVI) remains incompletely understood.
Purpose of the Study:
- To investigate the association between CKD, including early stages, and morbidity, in-hospital outcomes, and costs in patients undergoing TAVI.
- To establish the influence of CKD on risk stratification for TAVI patients.
Main Methods:
- Retrospective analysis of nationwide data from hospitalized patients in Germany who underwent TAVI between 2010 and 2013.
- Evaluation of the impact of CKD on mortality, bleeding, acute kidney injury (AKI), stroke, length of hospital stay, and reimbursements.
Main Results:
- Of 28,716 TAVI patients, 39.0% had CKD, presenting with higher comorbidity rates and risk scores.
- CKD stage ≥3 independently associated with increased in-hospital mortality (OR 1.71).
- CKD stage ≥4 independently associated with increased bleeding (OR 1.82) and AKI (stages 3 & 4: ORs 1.83-2.33). Stroke risk was paradoxically lower in advanced CKD stages (4 & 5).
- Patients with CKD experienced longer hospital stays but marginally higher reimbursements.
Conclusions:
- This nationwide analysis demonstrates a significant association between CKD and adverse outcomes post-TAVI.
- Pre-TAVI CKD staging is essential for accurate risk stratification and management of patients undergoing the procedure.
Background And Objectives:
Despitethe multiple depicted associations of CKD with reduced cardiovascular and overall prognoses, the association of CKD with outcome of patients undergoing transcatheter aortic valve implantation has still not been well described.
Design, Setting, Participants, & Measurements:
Data from all hospitalized patients who underwent transcatheter aortic valve implantation procedures between January 1, 2010 and December 31, 2013 in Germany were evaluated regarding influence of CKD, even in the earlier stages, on morbidity, in-hospital outcomes, and costs.
Results:
A total of 28,716 patients were treated with transcatheter aortic valve implantation. A total of 11,189 (39.0%) suffered from CKD. Patients with CKD were predominantly women; had higher rates of comorbidities, such as coronary artery disease, heart failure at New York Heart Association 3/4, peripheral artery disease, and diabetes; and had a 1.3-fold higher estimated logistic European System for Cardiac Operative Risk Evaluation value. In-hospital mortality was independently associated with CKD stage ≥3 (up to odds ratio, 1.71; 95% confidence interval, 1.35 to 2.17; P<0.05), bleeding was independently associated with CKD stage ≥4 (up to odds ratio, 1.82; 95% confidence interval, 1.47 to 2.24; P<0.001), and AKI was independently associated with CKD stages 3 (odds ratio, 1.83; 95% confidence interval, 1.62 to 2.06) and 4 (odds ratio, 2.33; 95% confidence interval, 1.92 to 2.83 both P<0.001). The stroke risk, in contrast, was lower for patients with CKD stages 4 (odds ratio, 0.23; 95% confidence interval, 0.16 to 0.33) and 5 (odds ratio, 0.24; 95% confidence interval, 0.15 to 0.39; both P<0.001). Lengths of hospital stay were, on average, 1.2-fold longer, whereas reimbursements were, on average, only 1.03-fold higher in patients who suffered from CKD.
Conclusions:
This analysis illustrates for the first time on a nationwide basis the association of CKD with adverse outcomes in patients who underwent transcatheter aortic valve implantation. Thus, classification of CKD stages before transcatheter aortic valve implantation is important for appropriate risk stratification.
