Advertisement

In-Hospital Outcomes of Transcatheter Aortic Valve Implantation in Patients With End-Stage Renal Disease on Dialysis from a Large National Database

      The outcomes of patients with end-stage renal disease on dialysis (chronic kidney disease stage 5 on dialysis [CKD 5D]) who undergo transcatheter aortic valve implantation (TAVI) are not well described due to the exclusion of this group in randomized trials. We analyzed the National Inpatient Sample database and compared clinical characteristics and in-hospital outcomes for patients with CKD 5D versus those without CKD 5D (nondialysis group) who underwent TAVI in 2011 to 2014 in the United States. The study population included 1,708 patients (4%) with CKD 5D and 40,481 patients (96%) without CKD 5D who underwent TAVI. Patients with CKD 5D were younger (75.3 ± 9.9 vs 81.4 ± 8.4 years, p <0.001), more likely to be men (62.8% vs 52%, p <0.001), and less likely to be Caucasian (73.6% vs 87.8%, p <0.001). Patients with CKD 5D were more likely to have congestive heart failure (16% vs 11.7%, p <0.001), diabetes with chronic complications (19% vs 5.4%, p <0.001), hypertension (86.5% vs 79.3%, p <0.001), and peripheral vascular disease (34.5% vs 29.4%, p <0.001), but were less likely to have atrial fibrillation (38.6% vs 44.8%, p <0.001) and chronic pulmonary disease (27.5% vs 33.6%, p <0.001). In-hospital mortality was significantly higher in the dialysis group (8.2% vs 4%; adjusted odds ratio 2.21, 95% confidence interval1.81 to 2.69, p <0.001) after adjusting for age, gender, co-morbidities, and hospital characteristics in a robust multivariate regression model. In conclusion, patients with CKD 5D who undergo TAVI have a higher in-hospital mortality than those without CKD 5D.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kim S.M.
        • Tripathy D.R.
        • Park S.W.
        • Park B.
        • Son J.W.
        • Lee J.W.
        • Youn Y.J.
        • Ahn S.G.
        • Ahn M.S.
        • Kim J.Y.
        • Yoo B.S.
        • Lee S.H.
        • Yoon J.
        Impact of chronic kidney disease on clinical outcomes in diabetic patients undergoing percutaneous coronary intervention in the era of newer-generation drug-eluting stents.
        Korean Circ J. 2017; 47: 222-230
        • Szerlip M.
        • Kim R.J.
        • Adeniyi T.
        • Thourani V.
        • Babaliaros V.
        • Bavaria J.
        • Herrmann H.C.
        • Anwaruddin S.
        • Makkar R.
        • Chakravarty T.
        • Rovin J.
        • Creighton D.
        • Miller D.C.
        • Baio K.
        • Walsh E.
        • Katinic J.
        • Letterer R.
        • Trautman L.
        • Herbert M.
        • Farkas R.
        • Rudolph J.
        • Brown D.
        • Holper E.M.
        • Mack M.
        The outcomes of transcatheter aortic valve replacement in a cohort of patients with end-stage renal disease.
        Catheter Cardiovasc Interv. 2016; 87: 1314-1321
        • Healthcare Cost and Utilization Project (HCUP)
        Overview of the National (Nationwide) Inpatient Sample (NIS).
        (Agency for Healthcare Research and Quality, Rockville, MD; Available at:)
        • Bhatia N.
        • Agrawal S.
        • Garg A.
        • Mohananey D.
        • Sharma A.
        • Agarwal M.
        • Garg L.
        • Agrawal N.
        • Singh A.
        • Nanda S.
        • Shirani J.
        Trends and outcomes of infective endocarditis in patients on dialysis.
        Clin Cardiol. 2017; https://doi.org/10.1002/clc.22688
        • Ross Jr, J.
        • Braunwald E.
        Aortic stenosis.
        Circulation. 1968; 38: 61-67
        • Urena P.
        • Malergue M.C.
        • Goldfarb B.
        • Prieur P.
        • Guedon-Rapoud C.
        • Petrover M.
        Evolutive aortic stenosis in hemodialysis patients: analysis of risk factors.
        Nephrologie. 1999; 20: 217-225
        • Kazancioglu R.
        Risk factors for chronic kidney disease: an update.
        Kidney Int Suppl (2011). 2013; 3: 368-371
        • Kambur T.R.
        • Das M.
        • Agarwal R.
        The natural history of symptomatic cardiac conduction-system disease in end-stage renal disease.
        Nephrol Dial Transplant. 2016; 31: 1973-1975
        • Nazif T.M.
        • Dizon J.M.
        • Hahn R.T.
        • Xu K.
        • Babaliaros V.
        • Douglas P.S.
        • El-Chami M.F.
        • Herrmann H.C.
        • Mack M.
        • Makkar R.R.
        • Miller D.C.
        • Pichard A.
        • Tuzcu E.M.
        • Szeto W.Y.
        • Webb J.G.
        • Moses J.W.
        • Smith C.R.
        • Williams M.R.
        • Leon M.B.
        • Kodali S.K.
        • Office P.P.
        Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry.
        JACC Cardiovasc Interv. 2015; 8: 60-69
        • Latsios G.
        • Gerckens U.
        • Buellesfeld L.
        • Mueller R.
        • John D.
        • Yuecel S.
        • Syring J.
        • Sauren B.
        • Grube E.
        “Device landing zone” calcification, assessed by MSCT, as a predictive factor for pacemaker implantation after TAVI.
        Catheter Cardiovasc Interv. 2010; 76: 431-439
        • Al-Azzam F.
        • Greason K.L.
        • Krittanawong C.
        • Williamson E.E.
        • McLeod C.J.
        • King K.S.
        • Mathew V.
        The influence of native aortic valve calcium and transcatheter valve oversize on the need for pacemaker implantation after transcatheter aortic valve insertion.
        J Thorac Cardiovasc Surg. 2017; 153 (e1051): 1056-1062
        • Kaw D.
        • Malhotra D.
        Platelet dysfunction and end-stage renal disease.
        Semin Dial. 2006; 19: 317-322
        • Attallah N.
        • Yassine L.
        • Fisher K.
        • Yee J.
        Risk of bleeding and restenosis among chronic kidney disease patients undergoing percutaneous coronary intervention.
        Clin Nephrol. 2005; 64: 412-418
        • Isik T.
        • Ayhan E.
        • Uluganyan M.
        • Gunaydin Z.Y.
        • Uyarel H.
        Predictors of prolonged in-hospital stay after primary percutaneous coronary intervention for ST-elevation myocardial infarction.
        Angiology. 2016; 67: 756-761
        • Apel M.
        • Maia V.P.
        • Zeidan M.
        • Schinkoethe C.
        • Wolf G.
        • Reinhart K.
        • Sakr Y.
        End-stage renal disease and outcome in a surgical intensive care unit.
        Crit Care. 2013; 17: R298