title: Impact of preoperative chronic kidney disease on short- and long-term outcomes after transcatheter aortic valve implantation: a Pooled-RotterdAm-Milano-Toulouse In Collaboration Plus (PRAGMATIC-Plus) initiative substudy.
abstract: BACKGROUND
  Only limited and conflicting data on the impact of preoperative chronic kidney disease (CKD) on outcomes after transcatheter aortic valve implantation (TAVI) are available.
  
  
  METHODS
  We retrospectively analyzed pooled data from the prospective TAVI databases of 4 centers (942 patients). Valve Academic Research Consortium end point definitions were used. The outcomes were compared among patients with normal estimated glomerular filtration rate (≥90 mL/min), mild (60-89 mL/min), moderate (30-59 mL/min), and severe (<30 mL/min) CKD and those on chronic hemodialysis (HD). The primary end point was 1-year survival.
  
  
  RESULTS
  A total of 109 patients had a normal estimated glomerular filtration rate (11.6%); 329 (34.9%) had mild, 399 (42.5%) moderate, 72 (7.5%) severe CKD, and 33 (3.5%) were on HD. Baseline and procedural characteristics were similar among all groups except for Logistic EuroSCORE. Major stroke, life-threatening bleeding, all-cause 30-day mortality (HD 15.2%, severe CKD 8.3%, moderate CKD 8.3%, mild CKD 6.7%, normal 1.8%, P = .007) and 1-year survival (HD 54.8%, severe CKD 67.2%, moderate CKD 80.0%, mild CKD 85.2%, normal eGFR 91.4%, HD vs severe CKD P = .23, severe CKD vs moderate CKD P = .002, moderate CKD vs mild CKD P = .04, moderate CKD vs normal eGFR P = .03, by log-rank test) differed significantly across groups. Through multivariable analysis, HD and severe CKD were independently associated with an increased risk of 1-year mortality (hazard ratios 5.07 [95% CI 1.79-14.35, P = .002] and 4.03 [95% CI 1.52-10.69, P = .005], respectively).
  
  
  CONCLUSIONS
  Patients with CKD who undergo TAVI have a higher-risk profile and worse 30-day and 1-year outcomes. Chronic hemodialysis and severe preprocedural CKD are independently associated with an increased risk of 1-year mortality after TAVI.
authors.affiliation: Pôle Cardiovasculaire et Métabolique, Hôpital Rangueil, Toulouse, France. Electronic address: dumonteil.n@chu-toulouse.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dumonteil
authors.forename: Robert M A
authors.initials: RM
authors.lastname: van der Boon
authors.forename: Didier
authors.initials: D
authors.lastname: Tchetche
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.forename: Bertrand
authors.initials: B
authors.lastname: Marcheix
authors.forename: Gill L
authors.initials: GL
authors.lastname: Buchanan
authors.forename: Olivier
authors.initials: O
authors.lastname: Vahdat
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Peter P T
authors.initials: PP
authors.lastname: de Jaegere
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends