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Published on: June 3, 2018
The Potential Renal Protective Effect of Transcatheter Aortic Valve Replacement
Deepa Soodi1, Paul Yeung2, Peter Umukoro3
1Cardiology, Marshfield Clinic Health System, Marshfield, USA.
Insights
Transcatheter aortic valve replacement (TAVR) initially improves kidney function in patients with aortic stenosis. However, the long-term decline in estimated glomerular filtration rate (eGFR) is similar, regardless of pre-existing chronic kidney disease (CKD).
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Rising incidence of aortic stenosis (AS) presents a significant healthcare challenge.
- Transcatheter aortic valve replacement (TAVR) is increasingly utilized for symptomatic AS.
- Long-term renal function and mortality outcomes post-TAVR require further investigation.
Purpose of the Study:
- To evaluate long-term renal function changes up to three years post-TAVR.
- To compare outcomes in patients with and without chronic kidney disease (CKD).
- To assess the impact of TAVR on mortality in AS patients.
Main Methods:
- Retrospective review of 270 patients undergoing TAVR (2012-2017).
- Analysis of baseline and serial serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) up to three years.
- Patient stratification into CKD and non-CKD groups.
Main Results:
- Initial eGFR improvement at one month post-TAVR in both groups, returning to baseline by three months.
- Similar average eGFR decline of 5.3 mL/min/m² at three years, independent of CKD status.
- Higher mortality rates observed in CKD patients; CKD identified as a significant predictor of mortality.
Conclusions:
- TAVR leads to initial renal function improvement, potentially mitigating cardiorenal syndrome.
- Long-term eGFR decline post-TAVR is comparable between CKD and non-CKD patients.
- TAVR may offer renoprotective benefits, particularly for patients with CKD, despite higher overall mortality in this group.
Abstract:
Background The incidence of aortic stenosis (AS) is steadily increasing, posing a significant healthcare burden. Transcatheter aortic valve replacement (TAVR) is being used more frequently to treat patients with symptomatic AS. This study evaluated long-term changes in renal function and mortality in TAVR patients over a period of up to three years, including those with normal creatinine (Cr) levels and those with chronic kidney disease (CKD). Methods We conducted a retrospective review of 270 patients who underwent TAVR between 2012 and 2017 at a rural tertiary referral center. Collected data included baseline serum Cr and estimated glomerular filtration rate (eGFR), with follow-up measurements taken at 30 days, six months, one year, two years, and three years post-TAVR. Patients were categorized into two groups: those with CKD and those without. Results Both groups showed similar improvements in eGFR at one month (6.3 mL/min/m², p < 0.001). However, by three months, eGFR levels returned to their pre-TAVR baseline. At the three-year mark, an average decline of 5.3 mL/min/m² was observed in both groups (p < 0.001). Despite CKD patients having worse kidney function throughout the study period, the extent of eGFR reduction was similar between the CKD and non-CKD groups, indicating that eGFR decline was independent of CKD status. Mortality rates were higher in CKD patients (56.9 (39%) vs. 24.6 (22%); p = 0.006). Multivariate analysis identified CKD as the most reliable predictor of mortality. Conclusions Renal function significantly improved at one month post-TAVR in both CKD and non-CKD patients. Although eGFR initially improved after TAVR, the subsequent decline was similar in both groups, suggesting that the reduction in eGFR is independent of CKD status. Cardiorenal syndrome, which can occur with AS, may improve with TAVR. These findings support the potential renoprotective effect of TAVR in patients with CKD.
