Death and dialysis risk after transcatheter aortic valve replacement
Hansen JW, Foy A, Yadav P, Gilchrist I, Kozak M, Wang A, Wang DD, Eng M, Greenbaum A, O'Neill W. Death and dialysis risk after transcatheter aortic valve replacement. J Am Coll Cardiol. Mar 2017;69(11):1212-1212.
J Am Coll Cardiol
Background: Progression to renal replacement therapy (RRT) is a common concern for chronic kidney disease patients undergoing TAVR. Shared decision making requires accurate estimates on the need for RRT following TAVR; however, this information is unknown. We sought to quantify the need for RRT following TAVR based on pre-procedure GFR. Methods: The NCDR-TVT registry was used to identify all eligible patients that underwent TAVR and who had information on preprocedure GFR between November 2011 and September 2015. Patients were linked to Center for Medicare and Medicaid Services database to assess for the primary outcome of death or RRT at 30 days and one year. Patients were excluded if they were already on RRT in any form. Unadjusted and adjusted Cox proportional hazard regression models were generated to assess the association of GFR and primary outcome. Results: Data was reviewed from 44778 patients. Average age was 81.96 years and 48.67% were women. Preprocedure GFR was significantly associated with death and new RRT at 30 days and 1 year (table 1). The association between GFR and the endpoints was statistically significant after adjusting for known risk factors. Conclusions: Reduced preprocedure GFR is associated with a higher incidence of death and RRT following TAVR and increases substantially when the GFR is below 30. Approximately 1 out of every 6 patients with a GFR < 30 and 1 out of every 3 patients with a GFR < 15 will die or need RRT within 30 days following TAVR. (Table Presented).