Kidney Function Trajectories in Patients with and Without Chronic Kidney Disease Undergoing Transcatheter Aortic...

Background/Objectives: Transcatheter aortic valve replacement (TAVR) may improve systemic hemodynamics and kidney perfusion; however, its effect on long-term kidney function remains unclear. We evaluated kidney function trajectories before and after TAVR in patients with and without chronic kidney disease (CKD). Methods: This single-center retrospective cohort study included patients with severe aortic stenosis (AS) who underwent TAVR between June 2016 and December 2024. Overall, 314 eligible patients were classified by baseline estimated glomerular filtration rate (eGFR) as without CKD (≥60 mL/min/1.73 m²) or with CKD (<60 mL/min/1.73 m²). Linear mixed-effects models estimated pre- and post-TAVR eGFR slopes, which were compared between groups after covariate adjustment. Results: Median follow-up was 2.0 years. Adjusted pre-TAVR eGFR slopes were -2.11 (95% confidence interval [CI], -3.34 to -0.89) mL/min/1.73 m²/year in patients without CKD and -2.83 (95% CI, -3.65 to -2.01) mL/min/1.73 m²/year in patients with CKD. The post-TAVR slopes were -4.02 (95% CI, -5.68 to -2.35) mL/min/1.73 m²/year in patients without CKD and -0.83 (95% CI, -2.04 to 0.39) mL/min/1.73 m²/year in patients with CKD, with a significant group difference of 3.19 (95% CI, 1.44 to 4.94) mL/min/1.73 m²/year (p < 0.001). In patients with CKD, the post-TAVR slope improved relative to the pre-TAVR slope by 2.01 (95% CI, 0.51 to 3.50) mL/min/1.73 m²/year (p < 0.01), whereas no significant change was observed in those without CKD. Conclusions: eGFR decline after TAVR was attenuated in patients with CKD compared with those without CKD, suggesting that kidney function may be preserved through hemodynamic improvement following TAVR.