Chronic kidney disease and transcatheter aortic valve implantation

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Severe aortic stenosis often coexists with chronic kidney disease (CKD), increasing mortality and cardiovascular risks.
• Cardio-renal syndrome (CRS) describes the interplay between heart and kidney dysfunction, a common complication in these patients.
• Transcatheter aortic valve implantation (TAVI) aims to improve cardio-renal function, yet CKD patients face poorer outcomes.

Purpose of the Study:

• To evaluate the prognostic impact of chronic kidney disease (CKD) following transcatheter aortic valve implantation (TAVI).
• To identify optimal management strategies for preserving cardio-renal function in TAVI patients with CKD.
• To review the challenges and outcomes of TAVI in patients with advanced CKD and end-stage renal disease on hemodialysis.

Main Methods:

• Comprehensive literature review of studies investigating TAVI outcomes in patients with varying degrees of CKD.
• Analysis of data on mortality, cardiovascular events, and heart failure readmissions in CKD patients post-TAVI.
• Examination of existing evidence on management strategies for cardio-renal preservation during and after TAVI.

Main Results:

• Patients with CKD undergoing TAVI are associated with increased risks and poorer prognoses compared to non-CKD patients.
• TAVI procedures in patients with advanced CKD or on hemodialysis present significant challenges.
• Evidence suggests potential benefits of TAVI in improving cardio-renal function, but outcomes remain suboptimal in CKD populations.

Conclusions:

• Chronic kidney disease significantly impacts outcomes after TAVI, necessitating specialized care.
• Optimizing management to preserve cardio-renal function is critical for improving long-term prognosis in TAVI patients with CKD.
• Further research is needed to establish best practices for TAVI in the complex CKD population.