title: Evaluation of renal function before and after percutaneous mitral valve repair.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is strongly related to outcome in cardiovascular diseases. The relationship between treatment of mitral regurgitation (MR) and renal function is not well described. We sought to evaluate renal function before and after mitral valve repair by the MitraClip device.
  
  
  RESULTS
  Patients with moderate-to-severe or severe (3+ or 4+, respectively) MR by core laboratory determination who underwent transcatheter mitral valve repair with the MitraClip device in multicenter, investigational trials were included in this study. Estimated glomerular filtration rate (eGFR) was evaluated before and at hospital discharge, 30 days, 6 months, and 1 year after mitral valve repair. Eight hundred fifty-four patients with baseline mean eGFR 61.5 ± 23.1 mL/min/1.73 m(2) were studied, including 438 (51.3%) with eGFR ≥ 60 mL/min/1.73 m(2) (CKD stage 1 or 2), 371 (42.6%) with eGFR 30 to 59 mL/min/1.73 m(2) (CKD stage 3), and 52 (6.1%) with eGFR < 30 mL/min/1.73 m(2) (CKD stage 4 or 5). Baseline renal dysfunction was more prevalent in older patients with a history of heart failure, coronary artery disease, cerebrovascular disease, diabetes mellitus, hypertension, and atrial fibrillation. Baseline eGFR was associated with 1-year survival (P < 0.001) after MitraClip repair. At 1-year follow-up, the mean change in eGFR for the overall cohort was -1.0 ± 15.1 mL/min/1.73 m(2); for patients with CKD stage 1 or 2, stage 3, or stage 4 or 5, mean change was -4.1 ± 16.6, +2.6 ± 12.4, and +4.8 ± 9.5 mL/min/1.73 m(2), respectively. Linear mixed effect modeling demonstrated a strong association between MR and eGFR, and a statistically significant improvement in eGFR in patients with CKD stage 4 or 5 associated with MR reduction to ≤ 2+ (P = 0.007).
  
  
  CONCLUSIONS
  Renal dysfunction is associated with lower survival in patients with severe MR even after percutaneous mitral valve repair. Reduction in MR severity by the MitraClip device is associated with improvement in renal function at 1 year in patients with baseline renal dysfunction.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifiers: NCT00209274, NCT01931956, NCT01940120.
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.). a.wang@duke.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Chithra
authors.initials: C
authors.lastname: Sangli
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Scott
authors.initials: S
authors.lastname: Lim
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Paul
authors.initials: P
authors.lastname: Grayburn
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Elyse
authors.initials: E
authors.lastname: Foster
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Donald
authors.initials: D
authors.lastname: Glower
authors.affiliation: From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
mesh_terms: D000279:Administration, Cutaneous; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000378:metabolism / Q000601:surgery*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D016019:Survival Analysis
chemical_list: D003404:Creatinine
keywords: catheterization; kidney; mitral valve; valve