Author + information
- Received July 13, 2017
- Revision received August 17, 2017
- Accepted September 1, 2017
- Published online October 16, 2017.
- James W. Hansen, DOa,∗ (, )
- Andrew Foy, MDb,
- Pradeep Yadav, MDb,
- Ian C. Gilchrist, MDb,
- Mark Kozak, MDb,
- Amanda Stebbins, MSc,
- Roland Matsouaka, PhDc,
- Sreekanth Vemulapalli, MDc,
- Alice Wang, MDc,
- Dee Dee Wang, MDd,
- Marvin H. Eng, MDd,
- Adam B. Greenbaum, MDd and
- William O. O’Neill, MDd
- aLahey Hospital and Medical Center, Burlington, Massachusetts
- bPenn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- cDuke Clinical Research Institute, Durham, North Carolina
- dHenry Ford Health System, Detroit, Michigan
- ↵∗Address for correspondence:
Dr. James W. Hansen, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, Massachusetts 01805.
Objectives The authors sought to elucidate the true incidence of renal replacement therapy (RRT) after transcatheter aortic valve replacement (TAVR).
Background There is a wide discrepancy in the reported rate of RRT after TAVR (1.4% to 40%). The true incidence of RRT after TAVR is unknown.
Methods The STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) registry was linked to the Centers for Medicare & Medicaid database to identify all patients that underwent TAVR from November 2011 through September 2015 and their outcomes. The authors compared rates of death, new RRT, and a composite of both as a function of pre-procedure glomerular filtration rate (GFR), both in stages of chronic kidney disease (CKD), as well as on a continuous scale.
Results Pre-procedure GFR is associated with the risk of death and new RRT after TAVR when GFR is <60 ml/min/m2, and increases significantly when GFR falls below 30 ml/min/m2. Incremental increases in GFR of 5 ml/min/m2 were statistically significant (unadjusted hazard ratio: 0.71; p < 0.001) at 30 days, and continued to be significant at 1 year when pre-procedure GFR was <60 ml/min/m2. One in 3 CKD stage 4 patients will be dead within 1 year, with 14.6% (roughly 1 in 6) requiring dialysis. In CKD stage 5, more than one-third of patients will require RRT within 30 days; nearly two-thirds will require RRT at 1 year.
Conclusions In both unadjusted and adjusted analysis, pre-procedural GFR was associated with the outcomes of death and new RRT. Increasing CKD stage leads to an increased risk of death and/or RRT. Continuous analysis showed significant differences in outcomes in all levels of CKD when GFR was <60 ml/min/m2. Pre-procedure GFR should be considered when selecting CKD patients for TAVR.
This project was funded through the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) (STS/ACC TVT registry). Dr. Vemulapalli has received grants from the American College of Cardiology, Society of Thoracic Surgeons, Abbott Vascular, and PCORI (Patient Centered Outcomes Research Institute). Dr. Greenbaum is a proctor for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 13, 2017.
- Revision received August 17, 2017.
- Accepted September 1, 2017.
- 2017 American College of Cardiology Foundation
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