Prognostic Value of Chronic Kidney Disease After Transcatheter Aortic Valve Implantation
Key result
Baseline CKD stage 4 is linked to ~191% higher 1-year mortality post-TAVI versus stages 1-2.
- HR 2.91
- 95% CI 1.73-4.90
- P<0.001
- n=642
Why the study?
The prognostic value of impaired renal function according to CKD classification had not been thoroughly investigated in very elderly TAVI cohorts.
Does advanced chronic kidney disease increase the risk of mortality in patients undergoing transcatheter aortic valve implantation?
Population
642 consecutive patients who underwent TAVI
Comparison
CKD stage 1+2 vs CKD stage 3a vs CKD stage 3b vs CKD stage 4
Design
Prospective cohort study
Follow-up
1 year
Authors
Discussion
Loading...
Member takes
Implication
Highlights the need for careful risk stratification in elderly TAVI candidates with renal impairment;.
Key Points
- To assess the prognostic influence of chronic kidney disease (CKD) staging on 30-day and 1-year clinical outcomes in elderly patients undergoing transcatheter aortic valve implantation (TAVI).
- Prospective observational study of 642 consecutive patients (mean age: 83.5 ± 6.5 years; logistic EuroSCORE: 20.0%) undergoing TAVI.
- Patients were categorized by baseline estimated glomerular filtration rate into CKD stage 1+2 (≥60 ml/min/1.73 m², n=218), stage 3a (45–59 ml/min/1.73 m², n=182), stage 3b (30–44 ml/min/1.73 m², n=181), and stage 4 (15–29 ml/min/1.73 m², n=61).
- Multivariate Cox proportional hazards regression models were used to adjust for confounding variables.
- Thirty-day mortality increased significantly across stages: 6.9% (stage 1+2) vs. 8.8% (stage 3a) vs. 13.3% (stage 3b) vs. 26.2% (stage 4) (p=0.002), with CKD stage 4 independently predicting 30-day mortality (HR: 3.04; 95% CI: 1.43–6.49; p=0.004).
- Cumulative 1-year mortality rates rose across stages (17.2% vs. 23.4% vs. 29.2% vs. 47.8%, p<0.001), with CKD stage 3b (HR: 1.71; 95% CI: 1.09–2.68; p=0.020) and CKD stage 4 (HR: 2.91; 95% CI: 1.73–4.90; p<0.001) serving as independent predictors of midterm death compared with CKD stage 1+2.
Study Design
Type
Cohort (n=642)
Structured PICO
Does advanced chronic kidney disease increase the risk of mortality in patients undergoing transcatheter aortic valve implantation?
P
Population
642 consecutive patients (mean age 83.5 years) undergoing TAVI, prospectively collected and stratified by chronic kidney disease stage, followed for up to 1 year.
E
Exposure
Transcatheter aortic valve implantation (TAVI) in patients with advanced chronic kidney disease (CKD stages 3a, 3b, and 4)
C
Comparator
Transcatheter aortic valve implantation (TAVI) in patients with CKD stage 1+2 (eGFR ≥60 ml/min/1.73 m²)
O
Outcome
30-day and cumulative 1-year mortalityhard clinical
Main Result
Hazard Ratio: 2.91 (95% CI 1.73–4.9)
Absolute Event Rate: 47.8% vs 17.2%
p-value: p=<0.001
Advanced chronic kidney disease (stages 3b and 4) is a strong independent predictor of early and midterm mortality after transcatheter aortic valve implantation.
Cite This Study
Yamamoto et al. (2013) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=642). Chronic kidney disease (CKD) stage 4 vs. CKD stage 1+2 was evaluated on Cumulative 1-year mortality (HR 2.91, 95% CI 1.73-4.90, p=<0.001). In patients undergoing TAVI, baseline CKD stage 4 was associated with significantly higher 1-year mortality compared to CKD stage 1+2 (47.8% vs 17.2%; HR 2.91; 95% CI 1.73-4.90; P<0.001).