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Updated: May 31, 2026

Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Differential effect of chronic kidney disease on right-sided extravalvular damage in low-flow, low-gradient aortic

Eric J Kim1, Yash Prakash1, Hassan Beesley1

  • 1Samuel Bronfman Department of Medicine at Mount Sinai Hospital, New York, New York.

The Journal of Invasive Cardiology
|May 28, 2026
PubMed

Insights

Advanced kidney dysfunction and right-sided damage significantly increase mortality after transcatheter aortic valve replacement (TAVR) in low-flow, low-gradient aortic stenosis (LFLG AS), especially in paradoxical subtypes.

Area of Science:

  • Cardiology
  • Nephrology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is a key intervention for low-flow, low-gradient aortic stenosis (LFLG AS).
  • Chronic kidney disease (CKD) and right-sided extravalvular damage (RSED) complicate risk assessment in TAVR patients.
  • The interplay between CKD, RSED, and outcomes in LFLG AS subtypes is not fully understood.

Purpose of the Study:

  • To investigate the association between CKD stages and RSED in patients with LFLG AS undergoing TAVR.
  • To evaluate the combined impact of CKD and RSED on post-TAVR mortality across LFLG AS subtypes.

Main Methods:

  • Retrospective analysis of 402 patients with LFLG AS who underwent TAVR (2019-2022).
  • Stratification by CKD stage (including end-stage renal disease [ESRD]) and LFLG AS subtype (classical vs. paradoxical).
  • RSED defined by pulmonary hypertension, tricuspid regurgitation, or RV systolic dysfunction; statistical models assessed associations and mortality.

Main Results:

  • End-stage renal disease (ESRD) was independently linked to RSED and RV dysfunction.
  • ESRD increased RV dysfunction in paradoxical LFLG AS but not classical.
  • Both advanced CKD and RSED independently raised post-TAVR mortality; their combination significantly elevated mortality in paradoxical LFLG AS.

Conclusions:

  • Advanced renal dysfunction is associated with RSED in LFLG AS patients.
  • The combination of RSED and advanced CKD has a potentially multiplicative impact on mortality in paradoxical LFLG AS.
Abstract

Keywords:
aortic stenosischronic kidney diseaselow-flow low-gradient aortic stenosistranscatheter aortic valve replacement

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