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5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
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Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American
Circulation
|May 13, 2021
Summary
Aortic stenosis (AS) is more common and severe in patients with chronic kidney disease (CKD). This review guides complex management decisions for AS in CKD patients undergoing aortic valve replacement, emphasizing a heart-kidney team approach.
Area of Science:
- Cardiology
- Nephrology
- Cardiovascular Imaging
Background:
- Aortic stenosis (AS) presents unique challenges in patients with chronic kidney disease (CKD).
- CKD exacerbates AS prevalence, progression, and unpredictability.
- CKD is linked to poorer outcomes post-aortic valve replacement (AVR).
Purpose of the Study:
- To summarize AS epidemiology and pathophysiology in CKD.
- To evaluate cardiovascular imaging in AS-CKD.
- To review AVR outcomes and perioperative management for AS-CKD patients.
Main Methods:
- Literature review of epidemiological, pathophysiological, and clinical data.
- Analysis of noninvasive cardiovascular imaging (echocardiography, advanced techniques).
- Critical appraisal of surgical AVR vs. transcatheter AVR outcomes in CKD.
Main Results:
- AS is more prevalent and aggressive in CKD patients.
- CKD patients face heightened risks during and after AVR.
- Limited randomized trial data necessitates reliance on observational evidence.
Conclusions:
- A multidisciplinary heart-kidney team approach is crucial for optimal perioperative management.
- Guidance is provided for selecting AVR strategy and prosthesis in AS-CKD.
- Evidence synthesis aims to support complex clinical decision-making in this high-risk group.
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