TAVR does not worsen chronic kidney disease

Reuters Health – 17/09/2020 – Renal impairment may stay stable or even show improvement after transcatheter aortic-valve replacement (TAVR) in most patients with chronic kidney disease (CKD), according to an analysis of data from clinical trials.

Poor baseline and post-operative renal function are risk factors for in-hospital and short- and intermediate-term mortality following TAVR, Dr. Robert J. Cubeddu of Cleveland Clinic Florida, in Weston, and colleagues note in the Journal of the American College of Cardiology. But it has been unclear what effect, if any, the procedure itself might have on renal impairment.

To investigate, the researchers examined data on more than 5,000 patients with severe aortic stenosis who underwent TAVR between 2007 and 2014. At baseline, 91% had CKD of stage 2 or higher.

Seven days after the procedure, CKD stage was either improved or unchanged in most of the 2,892 patients with data available on pre- and post-TAVR estimated glomerular filtration rate (eGFR). Specifically, between 77% and 99% of patients showed improved or unchanged CKD stage, and only 70 patients (2.0%) required dialysis.

Both higher pre-TAVR eGFR and a transfemoral approach were significantly associated with higher post-TAVR eGFR.

Lower post-TAVR eGFR was associated with factors such as greater BMI, diabetes and greater left ventricular hypertrophy. Lower baseline and longitudinal post-TAVR eGFR were associated with lower intermediate-term survival.

The researchers conclude, “CKD stage is more likely to stay the same or improve than worsen.” And, they add, “Aortic stenosis may contribute to cardiorenal syndrome that improves with TAVR.”

Dr. Benjamin Z. Galper of Mid-Atlantic Permanente Medical Group, in McLean, Virginia, co-author of an accompanying editorial, told Reuters Health by email, “Current thinking has been that TAVR should be approached with caution in patients with chronic kidney disease as it may increase the risk of progression to dialysis. This study challenges that paradigm and makes the compelling argument that by increasing blood flow from the heart to the kidneys that TAVR may actually improve kidney function in this high-risk patient population.”

“It is remarkable that 89% of patients in the study demonstrated a stabilization or improvement in kidney function after TAVR indicating that we can not only safely recommend the procedure in this patient population, but that we should perhaps consider TAVR earlier in patients with severe symptomatic aortic stenosis who demonstrate progressive worsening of kidney function,” he said.

Dr. Cubeddu did not comment by press time.

By David Douglas

SOURCE: https://bit.ly/32DlmLk and https://bit.ly/2FsSZXv JACC, online September 14, 2020.