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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve Replacement
Tanush Gupta1, Kashish Goel2, Dhaval Kolte3
1Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Insights
Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) face higher in-hospital mortality after transcatheter aortic valve replacement (TAVR). Acute kidney injury (AKI) also significantly increases mortality risk in TAVR patients.
Area of Science:
- Cardiology
- Nephrology
- Medical Outcomes Research
Background:
- Chronic kidney disease (CKD) is a known risk factor for poor outcomes in surgical valve replacement.
- Limited data exists on CKD patients undergoing transcatheter aortic valve replacement (TAVR), particularly those on dialysis.
Purpose of the Study:
- To investigate the association between chronic kidney disease (CKD) and in-hospital outcomes following transcatheter aortic valve replacement (TAVR).
- To compare outcomes across patients with no CKD, CKD, and end-stage renal disease (ESRD) on dialysis undergoing TAVR.
Main Methods:
- Utilized the 2012-2014 National Inpatient Sample database for patients aged ≥18 undergoing TAVR.
- Classified patients into no CKD, CKD (without dialysis), and ESRD (on dialysis) groups using ICD-9-CM codes.
- Employed multivariable logistic regression with generalized estimating equations to analyze in-hospital outcomes.
Main Results:
- Higher in-hospital mortality was observed in CKD (4.5%) and ESRD (8.3%) groups compared to no CKD (3.8%).
- CKD and ESRD patients experienced increased rates of major adverse cardiovascular events, net adverse cardiovascular events, and pacemaker implantation.
- Acute kidney injury (AKI) and AKI requiring dialysis were linked to substantially higher in-hospital mortality, with no decline in AKI incidence over the study period.
Conclusions:
- CKD and ESRD are associated with significantly worse in-hospital outcomes after TAVR.
- Acute kidney injury (AKI) poses a substantial mortality risk for TAVR patients, and its incidence remains a concern.
- The findings highlight the importance of considering renal function in TAVR patient management and risk stratification.
Objectives:
This study sought to determine the association of chronic kidney disease (CKD) with in-hospital outcomes of transcatheter aortic valve replacement (TAVR).
Background:
CKD is a known independent risk factor for worse outcomes after surgical aortic valve replacement (SAVR). However, data on outcomes of patients with CKD undergoing TAVR are limited, especially in those on chronic dialysis.
Methods:
The authors used data from the 2012 to 2014 National Inpatient Sample database to identify all patients ≥18 years of age who underwent TAVR. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with no CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on long-term dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes.
Results:
Of 41,025 patients undergoing TAVR from 2012 to 2014, 25,585 (62.4%) had no CKD, 13,750 (33.5%) had CKD, and 1,690 (4.1%) had ESRD. Compared with patients with no CKD, in-hospital mortality was significantly higher in patients with CKD or ESRD (3.8% vs. 4.5% vs. 8.3%; adjusted odds ratio [no CKD as reference]: 1.39 [95% confidence interval: 1.24 to 1.55] for CKD and 2.58 [95% confidence interval: 2.09 to 3.13] for ESRD). Patients with CKD or ESRD had a higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke), net adverse cardiovascular events (composite of major adverse cardiovascular events, major bleeding, or vascular complications), and pacemaker implantation compared with patients without CKD. Acute kidney injury (AKI) and AKI requiring dialysis were associated with several-fold higher risk-adjusted in-hospital mortality in patients in the no CKD and CKD groups. Moreover, the incidence of AKI and AKI requiring dialysis did not decline during the study period.
Conclusions:
Patients with CKD or ESRD have worse in-hospital outcomes after TAVR. AKI is associated with higher in-hospital mortality in patients undergoing TAVR and the incidence of AKI has not declined over the years.
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