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Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement

Abstract : Background The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic-valve replacement (AVR) versus conservative management on long-term mortality by stage of CKD. Methods and Results We included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate: no CKD, mild CKD, moderate CKD, and severe CKD. The 5-year survival rate was 71 +/- 1% for patients without CKD, 62 +/- 2% for those with mild CKD, 54 +/- 3% for those with moderate CKD, and 34 +/- 4% for those with severe CKD (P<0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all-cause (hazard ratio [HR] [95% CI]=1.36 [1.08-1.71];P=0.009 and HR [95% CI]=2.16 [1.67-2.79];P<0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03-1.88];P=0.031 and HR [95% CI]=1.69 [1.18-2.41];P=0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (P=0.002) and severe CKD (P<0.001). AVR was associated with a marked reduction in all-cause and cardiovascular mortality versus conservative management for each CKD group (allP<0.001). The joint-test showed no interaction between AVR and CKD stages (P=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (allP<0.0017). Conclusions In severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all-cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR.
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Soumis le : vendredi 18 février 2022 - 11:26:27
Dernière modification le : mercredi 24 août 2022 - 10:12:23

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Yohann Bohbot, Alexandre Candellier, Momar Diouf, Dan Rusinaru, Alexandre Altes, et al.. Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement. Journal of the American Heart Association, Wiley-Blackwell, 2020, 9 (19), ⟨10.1161/JAHA.120.017190⟩. ⟨hal-03579731⟩



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