Key result
Baseline CKD linked to ~29% higher in-hospital mortality in patients undergoing MitraClip.
Why the study?
MitraClip is an established treatment in high surgical risk patients, but limited data are available on outcomes in patients with baseline renal dysfunction.
Does baseline kidney disease worsen in-hospital outcomes and 30-day readmissions in patients undergoing transcatheter mitral valve repair with MitraClip?
Cohort (n=13,563)
Yes
Does baseline kidney disease worsen in-hospital outcomes and 30-day readmissions in patients undergoing transcatheter mitral valve repair with MitraClip?
Effect estimate: OR 1.29 (95% CI 1.01-1.65)
Absolute Event Rate: 2.5% vs 2%
p-value: p=0.04
Baseline kidney disease, particularly end-stage renal disease, is associated with significantly worse in-hospital mortality and higher 30-day readmission rates following transcatheter mitral valve repair with MitraClip.
CKD may heighten peri-procedural risk awareness for MitraClip; leaves open whether optimization alters outcomes in prospective studies.
OBJECTIVES: This study sought to determine the impact of baseline chronic kidney disease (CKD) on in-hospital outcomes of transcatheter mitral valve repair with MitraClip (MC). BACKGROUND: MC is now an established treatment in high surgical risk patients. However, limited data are available on outcomes of MC in patients with baseline renal dysfunction. METHODS: The authors used data from January 2014 to December 2017 National Readmission Database to identify all patients ≥18 years of age who underwent MC. International classification of diseases (ICD)-9 and ICD-10 codes were used to identify patients with no-CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes. RESULTS: Of 13,563 patients undergoing MC, 8,935 (65.8%) had no-CKD, 4,152 (30.6%) had CKD, and 476 (3.5%) had ESRD. ESRD patients compared to CKD and no-CKD had significantly higher mortality (7.2% vs. 2.5% vs. 2.0%; p < .001), higher incidence of bleeding, blood transfusions, and 30 day all cause readmission. CKD patients compared to no-CKD had significantly higher mortality (odds ratio-1.29; CI 1.01-1.65; p = .04), acute kidney injury (odds ratio-3.0; CI 2.69-3.34; p < .001), new in-hospital hemodialysis (odds ratio- 2.70; CI 1.57-4.62; p < .001), blood transfusions, 30 day all cause and congestive heart failure (CHF) readmissions. In-hospital stroke and cardiac tamponade did not differ between the three groups. Patients with baseline kidney disease undergoing MC had higher mortality at high volume centers compared to low volume centers. CHF was the most common cause of readmission postMC in patients with or without preprocedural kidney disease. CONCLUSION: Patients with baseline kidney disease have worse outcomes after MC with higher readmission rates requiring careful patient selection and follow up in this population.
No takes yet. Share an insight, caveat, or question.
Raheja et al. (2020) conducted a cohort in Transcatheter mitral valve repair with MitraClip (n=13,563). Baseline chronic kidney disease (CKD) vs. No chronic kidney disease was evaluated on In-hospital mortality (OR 1.29, 95% CI 1.01-1.65, p=0.04). Baseline chronic kidney disease in patients undergoing MitraClip was associated with higher in-hospital mortality compared to no kidney disease (OR 1.29; 95% CI 1.01-1.65; p=0.04).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: