Prognostic Impact of Kidney Function before Transcatheter Aortic Valve Implantation - A Nationwide study

Background

Prognosis after transcatheter aortic valve implantation (TAVI) keeps improving, yet some high-risk groups persist with chronic kidney disease being one. Contemporary data on the prognostic importance of pre-TAVI kidney function are sparse, leaving uncertainty regarding which patients derive limited benefit from TAVI.

Aim

To describe the association between pre-procedural kidney function and long-term outcomes in TAVI patients.

Methods

We used Danish nationwide registries to identify patients with aortic stenosis undergoing TAVI between 2015 and end 2022. Patients were categorized by baseline eGFR: ≥60, 30-59, and <30 mL/min/1.73m2 or recent dialysis. We examined one-year all-cause mortality and hospitalization burden after TAVI and estimated relative risks using multivariable cox and logistic regression.

Results

We included 3,888 (60.7%) patients with eGFR ≥60 (58.4% male; median age, 80 years), 2,185 (34.1%) with eGFR 30–59 (55.5% male; median age, 83), and 336 (5,2%) with eGFR <30 or recent dialysis (58.0% male; median age, 81).

One-year all-cause mortality was 5.6% for eGFR ≥60, 9.1% for eGFR 30-59, and 19.6% for eGFR <30 or dialysis. Adjusted hazard ratio was significantly higher for eGFR 30–60 (aHR, 1.45; 95%CI, 1.19–1.78, p=0.0003) and eGFR <30 or dialysis (aHR, 3.07; 95%CI, 2.32–4.08, p<0.0001) than eGFR ≥60. Cumulative rehospitalization >14 days after TAVI was most frequent among patients with eGFR <30 or dialysis (18.4%).

Conclusion

We observed a stepwise association between pre-TAVI kidney function and post-TAVI one-year mortality as well as hospitalization burden. Kidney impairment potentially has substantial prognostic impact and should be incorporated into lifetime TAVI patient management.