Impact of Transcatheter Aortic Valve Replacement on Severity of Chronic Kidney Disease

PARTNER Trial Investigators

doi:10.1016/j.jacc.2020.07.048

Impact of Transcatheter Aortic Valve Replacement on Severity of Chronic Kidney Disease

PARTNER Trial Investigators

Research output: Contribution to journal › Article › peer-review

50 Scopus citations

Abstract

Background: The effect of transcatheter aortic valve replacement (TAVR) on kidney function stage in patients with aortic stenosis remains poorly understood. We hypothesized that in some patients, TAVR results in improved kidney function by alleviating cardiorenal syndrome. Objectives: The purpose of this study was to assess change in chronic kidney disease (CKD) stage following TAVR, identify variables associated with pre- and post-TAVR estimated glomerular filtration rate (eGFR), and assess association of post-TAVR eGFR with mortality. Methods: Patients (n = 5,190) receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2, and PARTNER 2 S3 trials between April 2007 and October 2014 were included. Pre-TAVR and procedural variables associated with post-TAVR eGFR, change in CKD stage at ≤7 days post-TAVR, and association of post-TAVR eGFR on intermediate-term mortality were assessed. Results: At baseline, CKD stage ≥2 was present in 91% of patients. CKD stage either improved or was unchanged following TAVR in the majority of patients (77% stage 1, 90% stage 2, 89% stage 3A, 94% stage 3B, and 99% stage 4). Progression to CKD stage 5 occurred in 1 (0.035%) of 2,892 patients within 7 days post-TAVR. Of 3,546 patients in whom data were available, 70 (2.0%) underwent post-TAVR dialysis. Higher pre-TAVR eGFR and transfemoral approach were strongly associated with higher post-TAVR eGFR. Lower baseline and longitudinal post-TAVR eGFR were associated with lower intermediate-term survival. Conclusions: In patients with severe aortic stenosis undergoing TAVR, even with baseline impaired eGFR, CKD stage is more likely to stay the same or improve than worsen. Aortic stenosis may contribute to cardiorenal syndrome that improves with TAVR.

Original language	English (US)
Pages (from-to)	1410-1421
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	76
Issue number	12
DOIs	https://doi.org/10.1016/j.jacc.2020.07.048
State	Published - Sep 22 2020

Funding

The PARTNER Trial was funded by Edwards Lifesciences. This study was supported in part by the Drs. Sidney and Becca Fleischer Heart and Vascular Education Chair and The Delos M. Cosgrove, MD, Chair for Heart Disease Research. Dr. Cubeddu has received fees for educational speaker and proctor-related activities through Edwards Lifesciences and Abbott Vascular. Dr. Blackstone serves as head of the Cleveland Clinic PARTNER Publications Office, which carries out independent analyses of data stemming from the PARTNER trials. Dr. Thourani serves as an advisor for Edwards Lifesciences, Abbott Vascular, Gore Vascular, Bard Medical, JenaValve, and Boston Scientific. Drs. Mack, Leon, and Svensson are members of the PARTNER Trial Executive Committee (no direct compensation). Dr. Kodali has received consulting fees from Edwards Lifesciences and Claret Medical; and serves on the Advisory Boards of Thubrikar Aortic Valve, Inc., Duratech, and VS Medtech. Dr. Herrmann has received institutional research funding from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received consulting fees from Abbott Vascular, Edwards Lifesciences, and Medtronic. Dr. Forcillo is an advisor for Medtronic and Edwards Lifesciences. Dr. Babaliaros serves as a consultant for Edwards Lifesciences; and has equity with Transmural Systems. Dr. Devireddy has received consulting fees from Medtronic, ReCor Medical, Shockwave Medical, and Vascular Dynamics. Dr. Leon has received research grants from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This paper was presented at the 2018 30th Annual Transcatheter Cardiovascular Therapeutics Meeting, on September 21 to 25, 2018, in San Diego, California. Benjamin Galper, MD, MPH, served as Guest Associate Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper. The PARTNER Trial was funded by Edwards Lifesciences. This study was supported in part by the Drs. Sidney and Becca Fleischer Heart and Vascular Education Chair and The Delos M. Cosgrove, MD, Chair for Heart Disease Research. Dr. Cubeddu has received fees for educational speaker and proctor-related activities through Edwards Lifesciences and Abbott Vascular. Dr. Blackstone serves as head of the Cleveland Clinic PARTNER Publications Office, which carries out independent analyses of data stemming from the PARTNER trials. Dr. Thourani serves as an advisor for Edwards Lifesciences, Abbott Vascular, Gore Vascular, Bard Medical, JenaValve, and Boston Scientific. Drs. Mack, Leon, and Svensson are members of the PARTNER Trial Executive Committee (no direct compensation). Dr. Kodali has received consulting fees from Edwards Lifesciences and Claret Medical; and serves on the Advisory Boards of Thubrikar Aortic Valve, Inc., Duratech, and VS Medtech. Dr. Herrmann has received institutional research funding from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic; and has received consulting fees from Abbott Vascular, Edwards Lifesciences, and Medtronic. Dr. Forcillo is an advisor for Medtronic and Edwards Lifesciences. Dr. Babaliaros serves as a consultant for Edwards Lifesciences; and has equity with Transmural Systems. Dr. Devireddy has received consulting fees from Medtronic, ReCor Medical, Shockwave Medical, and Vascular Dynamics. Dr. Leon has received research grants from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This paper was presented at the 2018 30th Annual Transcatheter Cardiovascular Therapeutics Meeting, on September 21 to 25, 2018, in San Diego, California. Benjamin Galper, MD, MPH, served as Guest Associate Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.

Keywords

aortic stenosis
cardiorenal syndrome
eGFR
survival analysis

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jacc.2020.07.048

Cite this

@article{579df63b56064335a385e17cbc79f287,

title = "Impact of Transcatheter Aortic Valve Replacement on Severity of Chronic Kidney Disease",

abstract = "Background: The effect of transcatheter aortic valve replacement (TAVR) on kidney function stage in patients with aortic stenosis remains poorly understood. We hypothesized that in some patients, TAVR results in improved kidney function by alleviating cardiorenal syndrome. Objectives: The purpose of this study was to assess change in chronic kidney disease (CKD) stage following TAVR, identify variables associated with pre- and post-TAVR estimated glomerular filtration rate (eGFR), and assess association of post-TAVR eGFR with mortality. Methods: Patients (n = 5,190) receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2, and PARTNER 2 S3 trials between April 2007 and October 2014 were included. Pre-TAVR and procedural variables associated with post-TAVR eGFR, change in CKD stage at ≤7 days post-TAVR, and association of post-TAVR eGFR on intermediate-term mortality were assessed. Results: At baseline, CKD stage ≥2 was present in 91% of patients. CKD stage either improved or was unchanged following TAVR in the majority of patients (77% stage 1, 90% stage 2, 89% stage 3A, 94% stage 3B, and 99% stage 4). Progression to CKD stage 5 occurred in 1 (0.035%) of 2,892 patients within 7 days post-TAVR. Of 3,546 patients in whom data were available, 70 (2.0%) underwent post-TAVR dialysis. Higher pre-TAVR eGFR and transfemoral approach were strongly associated with higher post-TAVR eGFR. Lower baseline and longitudinal post-TAVR eGFR were associated with lower intermediate-term survival. Conclusions: In patients with severe aortic stenosis undergoing TAVR, even with baseline impaired eGFR, CKD stage is more likely to stay the same or improve than worsen. Aortic stenosis may contribute to cardiorenal syndrome that improves with TAVR.",

keywords = "aortic stenosis, cardiorenal syndrome, eGFR, survival analysis",

author = "{PARTNER Trial Investigators} and Cubeddu, {Robert J.} and Asher, {Craig R.} and Lowry, {Ashley M.} and Blackstone, {Eugene H.} and Kapadia, {Samir R.} and Alu, {Maria C.} and Thourani, {Vinod H.} and Mack, {Michael J.} and Kodali, {Susheel K.} and Herrmann, {Howard C.} and Jessica Forcillo and Babaliaros, {Vasilis C.} and Devireddy, {Chandan M.} and Malaisrie, {S. Chris} and Davidson, {Charles J.} and Jaber, {Wael A.} and Leon, {Martin B.} and Svensson, {Lars G.}",

note = "Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation",

year = "2020",

month = sep,

day = "22",

doi = "10.1016/j.jacc.2020.07.048",

language = "English (US)",

volume = "76",

pages = "1410--1421",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "12",

}

TY - JOUR

T1 - Impact of Transcatheter Aortic Valve Replacement on Severity of Chronic Kidney Disease

AU - PARTNER Trial Investigators

AU - Cubeddu, Robert J.

AU - Asher, Craig R.

AU - Lowry, Ashley M.

AU - Blackstone, Eugene H.

AU - Kapadia, Samir R.

AU - Alu, Maria C.

AU - Thourani, Vinod H.

AU - Mack, Michael J.

AU - Kodali, Susheel K.

AU - Herrmann, Howard C.

AU - Forcillo, Jessica

AU - Babaliaros, Vasilis C.

AU - Devireddy, Chandan M.

AU - Malaisrie, S. Chris

AU - Davidson, Charles J.

AU - Jaber, Wael A.

AU - Leon, Martin B.

AU - Svensson, Lars G.

PY - 2020/9/22

Y1 - 2020/9/22

N2 - Background: The effect of transcatheter aortic valve replacement (TAVR) on kidney function stage in patients with aortic stenosis remains poorly understood. We hypothesized that in some patients, TAVR results in improved kidney function by alleviating cardiorenal syndrome. Objectives: The purpose of this study was to assess change in chronic kidney disease (CKD) stage following TAVR, identify variables associated with pre- and post-TAVR estimated glomerular filtration rate (eGFR), and assess association of post-TAVR eGFR with mortality. Methods: Patients (n = 5,190) receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2, and PARTNER 2 S3 trials between April 2007 and October 2014 were included. Pre-TAVR and procedural variables associated with post-TAVR eGFR, change in CKD stage at ≤7 days post-TAVR, and association of post-TAVR eGFR on intermediate-term mortality were assessed. Results: At baseline, CKD stage ≥2 was present in 91% of patients. CKD stage either improved or was unchanged following TAVR in the majority of patients (77% stage 1, 90% stage 2, 89% stage 3A, 94% stage 3B, and 99% stage 4). Progression to CKD stage 5 occurred in 1 (0.035%) of 2,892 patients within 7 days post-TAVR. Of 3,546 patients in whom data were available, 70 (2.0%) underwent post-TAVR dialysis. Higher pre-TAVR eGFR and transfemoral approach were strongly associated with higher post-TAVR eGFR. Lower baseline and longitudinal post-TAVR eGFR were associated with lower intermediate-term survival. Conclusions: In patients with severe aortic stenosis undergoing TAVR, even with baseline impaired eGFR, CKD stage is more likely to stay the same or improve than worsen. Aortic stenosis may contribute to cardiorenal syndrome that improves with TAVR.

AB - Background: The effect of transcatheter aortic valve replacement (TAVR) on kidney function stage in patients with aortic stenosis remains poorly understood. We hypothesized that in some patients, TAVR results in improved kidney function by alleviating cardiorenal syndrome. Objectives: The purpose of this study was to assess change in chronic kidney disease (CKD) stage following TAVR, identify variables associated with pre- and post-TAVR estimated glomerular filtration rate (eGFR), and assess association of post-TAVR eGFR with mortality. Methods: Patients (n = 5,190) receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2, and PARTNER 2 S3 trials between April 2007 and October 2014 were included. Pre-TAVR and procedural variables associated with post-TAVR eGFR, change in CKD stage at ≤7 days post-TAVR, and association of post-TAVR eGFR on intermediate-term mortality were assessed. Results: At baseline, CKD stage ≥2 was present in 91% of patients. CKD stage either improved or was unchanged following TAVR in the majority of patients (77% stage 1, 90% stage 2, 89% stage 3A, 94% stage 3B, and 99% stage 4). Progression to CKD stage 5 occurred in 1 (0.035%) of 2,892 patients within 7 days post-TAVR. Of 3,546 patients in whom data were available, 70 (2.0%) underwent post-TAVR dialysis. Higher pre-TAVR eGFR and transfemoral approach were strongly associated with higher post-TAVR eGFR. Lower baseline and longitudinal post-TAVR eGFR were associated with lower intermediate-term survival. Conclusions: In patients with severe aortic stenosis undergoing TAVR, even with baseline impaired eGFR, CKD stage is more likely to stay the same or improve than worsen. Aortic stenosis may contribute to cardiorenal syndrome that improves with TAVR.

KW - aortic stenosis

KW - cardiorenal syndrome

KW - eGFR

KW - survival analysis

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ER -

Impact of Transcatheter Aortic Valve Replacement on Severity of Chronic Kidney Disease

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