title: Association of CKD with Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation.
abstract: OBJECTIVE
  Despitethe multiple depicted associations of CKD with reduced cardiovascular and overall prognoses, the association of CKD with outcome of patients undergoing transcatheter aortic valve implantation has still not been well described.
  
  
  METHODS
  Data from all hospitalized patients who underwent transcatheter aortic valve implantation procedures between January 1, 2010 and December 31, 2013 in Germany were evaluated regarding influence of CKD, even in the earlier stages, on morbidity, in-hospital outcomes, and costs.
  
  
  RESULTS
  A total of 28,716 patients were treated with transcatheter aortic valve implantation. A total of 11,189 (39.0%) suffered from CKD. Patients with CKD were predominantly women; had higher rates of comorbidities, such as coronary artery disease, heart failure at New York Heart Association 3/4, peripheral artery disease, and diabetes; and had a 1.3-fold higher estimated logistic European System for Cardiac Operative Risk Evaluation value. In-hospital mortality was independently associated with CKD stage ≥3 (up to odds ratio, 1.71; 95% confidence interval, 1.35 to 2.17;P<0.05), bleeding was independently associated with CKD stage ≥4 (up to odds ratio, 1.82; 95% confidence interval, 1.47 to 2.24;P<0.001), and AKI was independently associated with CKD stages 3 (odds ratio, 1.83; 95% confidence interval, 1.62 to 2.06) and 4 (odds ratio, 2.33; 95% confidence interval, 1.92 to 2.83 bothP<0.001). The stroke risk, in contrast, was lower for patients with CKD stages 4 (odds ratio, 0.23; 95% confidence interval, 0.16 to 0.33) and 5 (odds ratio, 0.24; 95% confidence interval, 0.15 to 0.39; bothP<0.001). Lengths of hospital stay were, on average, 1.2-fold longer, whereas reimbursements were, on average, only 1.03-fold higher in patients who suffered from CKD.
  
  
  CONCLUSIONS
  This analysis illustrates for the first time on a nationwide basis the association of CKD with adverse outcomes in patients who underwent transcatheter aortic valve implantation. Thus, classification of CKD stages before transcatheter aortic valve implantation is important for appropriate risk stratification.
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine and.
authors.forename: Florian
authors.initials: F
authors.lastname: Lüders
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany; and.|Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Freiburg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaier
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Kaleschke
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine and.
authors.forename: Katrin
authors.initials: K
authors.lastname: Gebauer
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine and.
authors.forename: Matthias
authors.initials: M
authors.lastname: Meyborg
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine and.
authors.forename: Nasser M
authors.initials: NM
authors.lastname: Malyar
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine and.
authors.forename: Eva
authors.initials: E
authors.lastname: Freisinger
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Baumgartner
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine and.
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
authors.affiliation: Department of Cardiology and Angiology I, Heart Center, Freiburg University, Freiburg, Germany; and.
authors.forename: Jochen
authors.initials: J
authors.lastname: Reinöhl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007668:Kidney / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000191:economics / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D016896:Treatment Outcome
keywords: Acute Kidney Injury; Aortic Valve Stenosis; Comorbidity; Confidence Intervals; Economics; Female; Germany; Hospital Mortality; Humans; Length of Stay; Peripheral Arterial Disease; Prognosis; Renal Insufficiency, Chronic; Risk Assessment; Stroke; Transcatheter Aortic Valve Replacement; Treatment Outcome; chronic renal insufficiency; coronary artery disease; diabetes mellitus; heart failure