title: Impact of renal function on survival after transcatheter aortic valve implantation (TAVI): an analysis of the UK TAVI registry.
abstract: OBJECTIVE
  To determine the nature of the association between renal dysfunction and outcomes following transcatheter aortic valve implantation (TAVI) in all cases performed in the UK between 2007 and 2012.
  
  
  METHODS
  The UK TAVI registry was established to report outcomes on all TAVI procedures performed within the UK. Data were collected prospectively on 3980 patients from 1 January 2007 until 31 December 2012.
  
  
  RESULTS
  In total, 205 patients (5.5%) died during their admission. Moderate to advanced chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m(2)) was significantly associated with increased mortality, even after adjustment for risk factors (OR 1.45, 95% CI 1.03 to 2.05; p=0.04). For every 10 mL/min/1.73 m(2) decrease in eGFR, in-hospital mortality increased by 8.2% (95% CI 1.1% to 14.7%; p=0.03). In total 1119 patients (30.2%) died during the follow-up period (median 543 days). Moderate to advanced CKD (eGFR <45 mL/min/1.73 m(2)) was significantly associated with increased mortality, even after adjustment for risk factors (OR 1.36, 95% CI 1.17 to 1.58; p<0.001). For every 10 mL/min/1.73 m(2) decrease in eGFR, cumulative mortality increased by 4.4% (95% CI 1.2% to 7.5%; p=0.007). Preoperative kidney function and the need for preoperative dialysis treatment discriminated between patients who died and survived. However, predictive power was poor with none of the c-statistics being >0.6.
  
  
  CONCLUSIONS
  Pre-procedural renal dysfunction is associated, in a graded fashion independently of dialysis status, with worse outcomes, including mortality in patients undergoing TAVI.
authors.affiliation: Birmingham Cardio-Renal Group, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Ferro
authors.affiliation: Birmingham Cardio-Renal Group, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Chue
authors.affiliation: Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: Department of Cardiology, Royal Brompton and Harefield Hospitals, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Moat
authors.affiliation: Department of Cardiothoracic Surgery, King's College Hospital/King's Health Partners, London, UK.
authors.forename: Olaf
authors.initials: O
authors.lastname: Wendler
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK.
authors.forename: Uday
authors.identifier: http://orcid.org/0000-0002-7078-2760
authors.initials: U
authors.lastname: Trivedi
authors.affiliation: Birmingham Cardio-Renal Group, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: Birmingham Cardio-Renal Group, Birmingham Health Partners, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Townend
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement; D006113:United Kingdom