Chronic kidney disease as a potent amplifier of acute kidney injury and mortality following mitral transcatheter edge-to-edge repair (M-TEER): a systematic review and meta-analysis
R Fonseca Oliveira Suruagy Motta, N Schettino, P H Craveiro de Melo, A dos Santos Cleto, C Rodrigues Rosa, L Dexheimer da Silva, A Uchoa Leite Santana, A Colella Cervone, A Abizaid, E Martins Filho, B PileggiAbstract
Background
Chronic kidney disease (CKD) is a high-risk phenotype characterized by impaired renal reserve and chronic inflammation. In patients undergoing Mitral Transcatheter Edge-to-Edge Repair (M-TEER), these vulnerabilities may predispose to cardiorenal instability and adverse outcomes. This study aims to quantify the magnitude of CKD-associated risk to improve early identification and renal-protective strategies in this population.
Purpose
To determine the association between CKD and mortality and major in-hospital complications, with particular emphasis on acute kidney injury (AKI), in patients undergoing M-TEER.
Methods
A systematic search of PubMed, Embase, and Cochrane databases identified observational studies comparing outcomes in patients with CKD versus without CKD. The primary outcome was all-cause mortality. Secondary outcomes included AKI, cardiogenic shock, respiratory failure, vascular complications, bleeding, and stroke. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using fixed-effects models. Heterogeneity was assessed using $I^2$ statistics, and leave-one-out sensitivity analyses were performed.
Results
Seven studies comprising 23,831 patients (6,078 with CKD; 17,753 without CKD) were included. CKD was associated with a nearly threefold increased risk of AKI (RR 2.99, 95% CI 2.82–3.17; I2=90%), representing the most pronounced adverse association observed. CKD was also associated with higher mortality (RR 1.80, 95% CI 1.56–2.07; I2=62%), cardiogenic shock (RR 1.71, 95% CI 1.50–1.96; I2=32%), respiratory failure (RR 1.44, 95% CI 1.31–1.58; I2=36%), and vascular complications (RR 1.54, 95% CI 1.25–1.90; I2=85%). No significant association was observed for stroke (RR 0.86, 95% CI 0.65–1.15; I2=92%). Findings remained consistent across sensitivity analyses.
Conclusion
CKD markedly amplifies vulnerability to AKI and significantly increases mortality and multiple in-hospital complications in patients undergoing M-TEER. These findings reinforce CKD as a powerful cardiorenal risk phenotype and support the need for early renal-protective and risk-adapted management strategies in this high-risk population.