Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve Replacement

Tanush Gupta, Kashish Goel, Dhaval Kolte, Sahil Khera, Pedro A. Villablanca, Wilbert S. Aronow, Anna Bortnick, David P. Slovut, Cynthia C. Taub, Jorge Kizer, Robert T. Pyo, J. Dawn Abbott, Gregg C. Fonarow, Charanjit S. Rihal, Mario J. Garcia, Deepak L. Bhatt

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objectives This study sought to determine the association of chronic kidney disease (CKD) with in-hospital outcomes of transcatheter aortic valve replacement (TAVR). Background CKD is a known independent risk factor for worse outcomes after surgical aortic valve replacement (SAVR). However, data on outcomes of patients with CKD undergoing TAVR are limited, especially in those on chronic dialysis. Methods The authors used data from the 2012 to 2014 National Inpatient Sample database to identify all patients ≥18 years of age who underwent TAVR. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with no CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on long-term dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes. Results Of 41,025 patients undergoing TAVR from 2012 to 2014, 25,585 (62.4%) had no CKD, 13,750 (33.5%) had CKD, and 1,690 (4.1%) had ESRD. Compared with patients with no CKD, in-hospital mortality was significantly higher in patients with CKD or ESRD (3.8% vs. 4.5% vs. 8.3%; adjusted odds ratio [no CKD as reference]: 1.39 [95% confidence interval: 1.24 to 1.55] for CKD and 2.58 [95% confidence interval: 2.09 to 3.13] for ESRD). Patients with CKD or ESRD had a higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke), net adverse cardiovascular events (composite of major adverse cardiovascular events, major bleeding, or vascular complications), and pacemaker implantation compared with patients without CKD. Acute kidney injury (AKI) and AKI requiring dialysis were associated with several-fold higher risk-adjusted in-hospital mortality in patients in the no CKD and CKD groups. Moreover, the incidence of AKI and AKI requiring dialysis did not decline during the study period. Conclusions Patients with CKD or ESRD have worse in-hospital outcomes after TAVR. AKI is associated with higher in-hospital mortality in patients undergoing TAVR and the incidence of AKI has not declined over the years.

Original languageEnglish (US)
Pages (from-to)2050-2060
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume10
Issue number20
DOIs
StatePublished - Oct 23 2017

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Chronic Renal Insufficiency
Acute Kidney Injury
Chronic Kidney Failure
Dialysis
Hospital Mortality
Transcatheter Aortic Valve Replacement
Incidence
Logistic Models
Confidence Intervals
International Classification of Diseases
Aortic Valve
Surgical Instruments
Blood Vessels
Inpatients

Keywords

  • acute kidney injury
  • chronic kidney disease
  • end-stage renal disease
  • in-hospital mortality
  • major adverse cardiovascular event(s)
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Gupta, T., Goel, K., Kolte, D., Khera, S., Villablanca, P. A., Aronow, W. S., ... Bhatt, D. L. (2017). Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions, 10(20), 2050-2060. https://doi.org/10.1016/j.jcin.2017.07.044

Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve Replacement. / Gupta, Tanush; Goel, Kashish; Kolte, Dhaval; Khera, Sahil; Villablanca, Pedro A.; Aronow, Wilbert S.; Bortnick, Anna; Slovut, David P.; Taub, Cynthia C.; Kizer, Jorge; Pyo, Robert T.; Abbott, J. Dawn; Fonarow, Gregg C.; Rihal, Charanjit S.; Garcia, Mario J.; Bhatt, Deepak L.

In: JACC: Cardiovascular Interventions, Vol. 10, No. 20, 23.10.2017, p. 2050-2060.

Research output: Contribution to journalArticle

Gupta, T, Goel, K, Kolte, D, Khera, S, Villablanca, PA, Aronow, WS, Bortnick, A, Slovut, DP, Taub, CC, Kizer, J, Pyo, RT, Abbott, JD, Fonarow, GC, Rihal, CS, Garcia, MJ & Bhatt, DL 2017, 'Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve Replacement', JACC: Cardiovascular Interventions, vol. 10, no. 20, pp. 2050-2060. https://doi.org/10.1016/j.jcin.2017.07.044
Gupta, Tanush ; Goel, Kashish ; Kolte, Dhaval ; Khera, Sahil ; Villablanca, Pedro A. ; Aronow, Wilbert S. ; Bortnick, Anna ; Slovut, David P. ; Taub, Cynthia C. ; Kizer, Jorge ; Pyo, Robert T. ; Abbott, J. Dawn ; Fonarow, Gregg C. ; Rihal, Charanjit S. ; Garcia, Mario J. ; Bhatt, Deepak L. / Association of Chronic Kidney Disease With In-Hospital Outcomes of Transcatheter Aortic Valve Replacement. In: JACC: Cardiovascular Interventions. 2017 ; Vol. 10, No. 20. pp. 2050-2060.
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abstract = "Objectives This study sought to determine the association of chronic kidney disease (CKD) with in-hospital outcomes of transcatheter aortic valve replacement (TAVR). Background CKD is a known independent risk factor for worse outcomes after surgical aortic valve replacement (SAVR). However, data on outcomes of patients with CKD undergoing TAVR are limited, especially in those on chronic dialysis. Methods The authors used data from the 2012 to 2014 National Inpatient Sample database to identify all patients ≥18 years of age who underwent TAVR. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with no CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on long-term dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes. Results Of 41,025 patients undergoing TAVR from 2012 to 2014, 25,585 (62.4{\%}) had no CKD, 13,750 (33.5{\%}) had CKD, and 1,690 (4.1{\%}) had ESRD. Compared with patients with no CKD, in-hospital mortality was significantly higher in patients with CKD or ESRD (3.8{\%} vs. 4.5{\%} vs. 8.3{\%}; adjusted odds ratio [no CKD as reference]: 1.39 [95{\%} confidence interval: 1.24 to 1.55] for CKD and 2.58 [95{\%} confidence interval: 2.09 to 3.13] for ESRD). Patients with CKD or ESRD had a higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke), net adverse cardiovascular events (composite of major adverse cardiovascular events, major bleeding, or vascular complications), and pacemaker implantation compared with patients without CKD. Acute kidney injury (AKI) and AKI requiring dialysis were associated with several-fold higher risk-adjusted in-hospital mortality in patients in the no CKD and CKD groups. Moreover, the incidence of AKI and AKI requiring dialysis did not decline during the study period. Conclusions Patients with CKD or ESRD have worse in-hospital outcomes after TAVR. AKI is associated with higher in-hospital mortality in patients undergoing TAVR and the incidence of AKI has not declined over the years.",
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AU - Gupta, Tanush

AU - Goel, Kashish

AU - Kolte, Dhaval

AU - Khera, Sahil

AU - Villablanca, Pedro A.

AU - Aronow, Wilbert S.

AU - Bortnick, Anna

AU - Slovut, David P.

AU - Taub, Cynthia C.

AU - Kizer, Jorge

AU - Pyo, Robert T.

AU - Abbott, J. Dawn

AU - Fonarow, Gregg C.

AU - Rihal, Charanjit S.

AU - Garcia, Mario J.

AU - Bhatt, Deepak L.

PY - 2017/10/23

Y1 - 2017/10/23

N2 - Objectives This study sought to determine the association of chronic kidney disease (CKD) with in-hospital outcomes of transcatheter aortic valve replacement (TAVR). Background CKD is a known independent risk factor for worse outcomes after surgical aortic valve replacement (SAVR). However, data on outcomes of patients with CKD undergoing TAVR are limited, especially in those on chronic dialysis. Methods The authors used data from the 2012 to 2014 National Inpatient Sample database to identify all patients ≥18 years of age who underwent TAVR. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with no CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on long-term dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes. Results Of 41,025 patients undergoing TAVR from 2012 to 2014, 25,585 (62.4%) had no CKD, 13,750 (33.5%) had CKD, and 1,690 (4.1%) had ESRD. Compared with patients with no CKD, in-hospital mortality was significantly higher in patients with CKD or ESRD (3.8% vs. 4.5% vs. 8.3%; adjusted odds ratio [no CKD as reference]: 1.39 [95% confidence interval: 1.24 to 1.55] for CKD and 2.58 [95% confidence interval: 2.09 to 3.13] for ESRD). Patients with CKD or ESRD had a higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke), net adverse cardiovascular events (composite of major adverse cardiovascular events, major bleeding, or vascular complications), and pacemaker implantation compared with patients without CKD. Acute kidney injury (AKI) and AKI requiring dialysis were associated with several-fold higher risk-adjusted in-hospital mortality in patients in the no CKD and CKD groups. Moreover, the incidence of AKI and AKI requiring dialysis did not decline during the study period. Conclusions Patients with CKD or ESRD have worse in-hospital outcomes after TAVR. AKI is associated with higher in-hospital mortality in patients undergoing TAVR and the incidence of AKI has not declined over the years.

AB - Objectives This study sought to determine the association of chronic kidney disease (CKD) with in-hospital outcomes of transcatheter aortic valve replacement (TAVR). Background CKD is a known independent risk factor for worse outcomes after surgical aortic valve replacement (SAVR). However, data on outcomes of patients with CKD undergoing TAVR are limited, especially in those on chronic dialysis. Methods The authors used data from the 2012 to 2014 National Inpatient Sample database to identify all patients ≥18 years of age who underwent TAVR. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with no CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on long-term dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes. Results Of 41,025 patients undergoing TAVR from 2012 to 2014, 25,585 (62.4%) had no CKD, 13,750 (33.5%) had CKD, and 1,690 (4.1%) had ESRD. Compared with patients with no CKD, in-hospital mortality was significantly higher in patients with CKD or ESRD (3.8% vs. 4.5% vs. 8.3%; adjusted odds ratio [no CKD as reference]: 1.39 [95% confidence interval: 1.24 to 1.55] for CKD and 2.58 [95% confidence interval: 2.09 to 3.13] for ESRD). Patients with CKD or ESRD had a higher incidence of major adverse cardiovascular events (composite of death, myocardial infarction, or stroke), net adverse cardiovascular events (composite of major adverse cardiovascular events, major bleeding, or vascular complications), and pacemaker implantation compared with patients without CKD. Acute kidney injury (AKI) and AKI requiring dialysis were associated with several-fold higher risk-adjusted in-hospital mortality in patients in the no CKD and CKD groups. Moreover, the incidence of AKI and AKI requiring dialysis did not decline during the study period. Conclusions Patients with CKD or ESRD have worse in-hospital outcomes after TAVR. AKI is associated with higher in-hospital mortality in patients undergoing TAVR and the incidence of AKI has not declined over the years.

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KW - chronic kidney disease

KW - end-stage renal disease

KW - in-hospital mortality

KW - major adverse cardiovascular event(s)

KW - transcatheter aortic valve replacement

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