title: Reversibility of chronic kidney disease and outcomes following aortic valve replacement†.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) is prevalent in patients undergoing aortic valve replacement (AVR). We sought to evaluate the impact of AVR on estimated glomerular filtration rate (eGFR) levels and determine the impact of reversibility of CKD on postoperative outcomes.
  
  
  METHODS
  We retrospectively reviewed 2169 patients who underwent isolated AVR between 2000 and 2012. eGFR was calculated using the CKD-EPI formula. Based on preoperative eGFR, patients were divided into three groups: NoCKD (eGFR >60, n = 1417), ModCKD (eGFR = 30-60, n = 619) and SevCKD (eGFR = 15-30, n = 86). End-stage renal disease patients (eGFR <15 and/or dialysis, n = 47) were excluded from the study.
  
  
  RESULTS
  Before AVR, eGFR in the NoCKD, ModCKD and SevCKD groups was 81.3 ± 14.2, 48.9 ± 8.10 and 25.3 ± 4.12 ml/min/1.73 m(2), respectively. NoCKD patients showed a decline in eGFR during the first month postoperatively; thereafter, eGFR remained stable over 1 year. ModCKD and SevCKD patients demonstrated an initial improvement in eGFR, which peaked at 1 week postoperatively. In ModCKD, eGFR stabilized at a slightly lower level thereafter out to 1-year follow-up. In SevCKD, eGFR declined slightly out to 6 months postoperatively. Regardlessly, eGFR in ModCKD at 1 year and in SevCKD at 6 months postoperatively demonstrated sustained improvement over baseline eGFR. Reversibility of CKD was associated with a better long-term survival in the ModCKD group (P < 0.001) and short-term survival in the SevCKD group (P = 0.018).
  
  
  CONCLUSIONS
  AVR confers a marked initial improvement in eGFR, which is sustained in patients with ModCKD and SevCKD, and is associated with a better survival. The reversible nature of CKD in certain patients warrants careful consideration during preoperative risk scoring and stratification.
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Najjar
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Halit
authors.initials: H
authors.lastname: Yerebakan
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sorabella
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Guglielmetti
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Vandenberge
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurlansky
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University-New York Presbyterian Hospital, New York, NY, USA ig2006@cumc.columbia.edu.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Aortic valve replacement; Outcomes; Renal failure