Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement
Background The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic‐valve replacement (AVR) versus conservative management on long‐term mortality by stage of CKD. Methods and Results We included...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.017190 |
| _version_ | 1819175063554883584 |
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| author | Yohann Bohbot Alexandre Candellier Momar Diouf Dan Rusinaru Alexandre Altes Agnes Pasquet Sylvestre Maréchaux Jean‐Louis Vanoverschelde Christophe Tribouilloy |
| author_facet | Yohann Bohbot Alexandre Candellier Momar Diouf Dan Rusinaru Alexandre Altes Agnes Pasquet Sylvestre Maréchaux Jean‐Louis Vanoverschelde Christophe Tribouilloy |
| author_sort | Yohann Bohbot |
| collection | DOAJ |
| description | Background The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic‐valve replacement (AVR) versus conservative management on long‐term mortality by stage of CKD. Methods and Results We included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate: no CKD, mild CKD, moderate CKD, and severe CKD. The 5‐year survival rate was 71±1% for patients without CKD, 62±2% for those with mild CKD, 54±3% for those with moderate CKD, and 34±4% for those with severe CKD (P<0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all‐cause (hazard ratio [HR] [95% CI]=1.36 [1.08–1.71]; P=0.009 and HR [95% CI]=2.16 [1.67–2.79]; P<0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03–1.88]; P=0.031 and HR [95% CI]=1.69 [1.18–2.41]; P=0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (P=0.002) and severe CKD (P<0.001). AVR was associated with a marked reduction in all‐cause and cardiovascular mortality versus conservative management for each CKD group (all P<0.001). The joint‐test showed no interaction between AVR and CKD stages (P=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (all P<0.0017). Conclusions In severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all‐cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR. |
| first_indexed | 2024-12-22T20:48:55Z |
| format | Article |
| id | doaj.art-0f784206d2824453b7f4dac7a838bb0b |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T20:48:55Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-0f784206d2824453b7f4dac7a838bb0b2022-12-21T18:13:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-10-0191910.1161/JAHA.120.017190Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve ReplacementYohann Bohbot0Alexandre Candellier1Momar Diouf2Dan Rusinaru3Alexandre Altes4Agnes Pasquet5Sylvestre Maréchaux6Jean‐Louis Vanoverschelde7Christophe Tribouilloy8Department of Cardiology Amiens University Hospital Amiens FranceUR UPJV 7517 Jules Verne University of Picardie Amiens FranceDepartment of Clinical Research Amiens University Hospital Amiens FranceDepartment of Cardiology Amiens University Hospital Amiens FranceGroupement des Hôpitaux de l’Institut Catholique de Lille/Faculté Libre de Médecine Université Lille Nord de France Lille FrancePôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels BelgiumUR UPJV 7517 Jules Verne University of Picardie Amiens FrancePôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels BelgiumDepartment of Cardiology Amiens University Hospital Amiens FranceBackground The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic‐valve replacement (AVR) versus conservative management on long‐term mortality by stage of CKD. Methods and Results We included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate: no CKD, mild CKD, moderate CKD, and severe CKD. The 5‐year survival rate was 71±1% for patients without CKD, 62±2% for those with mild CKD, 54±3% for those with moderate CKD, and 34±4% for those with severe CKD (P<0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all‐cause (hazard ratio [HR] [95% CI]=1.36 [1.08–1.71]; P=0.009 and HR [95% CI]=2.16 [1.67–2.79]; P<0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03–1.88]; P=0.031 and HR [95% CI]=1.69 [1.18–2.41]; P=0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (P=0.002) and severe CKD (P<0.001). AVR was associated with a marked reduction in all‐cause and cardiovascular mortality versus conservative management for each CKD group (all P<0.001). The joint‐test showed no interaction between AVR and CKD stages (P=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (all P<0.0017). Conclusions In severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all‐cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR.https://www.ahajournals.org/doi/10.1161/JAHA.120.017190aortic stenosisaortic valve replacementchronic kidney diseasekidney failureoutcomesurvival |
| spellingShingle | Yohann Bohbot Alexandre Candellier Momar Diouf Dan Rusinaru Alexandre Altes Agnes Pasquet Sylvestre Maréchaux Jean‐Louis Vanoverschelde Christophe Tribouilloy Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic stenosis aortic valve replacement chronic kidney disease kidney failure outcome survival |
| title | Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement |
| title_full | Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement |
| title_fullStr | Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement |
| title_full_unstemmed | Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement |
| title_short | Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement |
| title_sort | severe aortic stenosis and chronic kidney disease outcomes and impact of aortic valve replacement |
| topic | aortic stenosis aortic valve replacement chronic kidney disease kidney failure outcome survival |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.017190 |
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