Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney Disease
Background We sought to study longer term survival in patients with aortic stenosis (AS) and nondialysis chronic kidney disease (CKD). Methods and Results We studied 839 patients (aged 78±9 years and 51% male) with CKD and AS on echocardiogram from 2005 to 2012. Longer term all‐cause and cardiovascu...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-02-01
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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.118.009980 |
| _version_ | 1811334041502220288 |
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| author | Krishna K. Patel Shailee Y. Shah Susana Arrigain Stacey Jolly Jesse D. Schold Sankar D. Navaneethan Brian P. Griffin Joseph V. Nally Milind Y. Desai |
| author_facet | Krishna K. Patel Shailee Y. Shah Susana Arrigain Stacey Jolly Jesse D. Schold Sankar D. Navaneethan Brian P. Griffin Joseph V. Nally Milind Y. Desai |
| author_sort | Krishna K. Patel |
| collection | DOAJ |
| description | Background We sought to study longer term survival in patients with aortic stenosis (AS) and nondialysis chronic kidney disease (CKD). Methods and Results We studied 839 patients (aged 78±9 years and 51% male) with CKD and AS on echocardiogram from 2005 to 2012. Longer term all‐cause and cardiovascular mortality was compared with a CKD group without AS, propensity matched for age, sex, race, left ventricular ejection fraction and CKD stage. Cox models were used to evaluate all‐cause mortality and competing‐risks regression models censored at time of aortic valve replacement to evaluate cardiac mortality in patients with AS and CKD. Overall, 511 (61%), 252 (30%), and 76 (9%) patients had CKD stages 3a, 3b, and 4, respectively; 93% had hypertension, 28% had diabetes mellitus, and 37% had coronary artery disease. In total, 185 (22%) had mild AS, 355 (42%) had moderate AS, and 299 (36%) had severe AS (66 symptomatic). Patients with CKD and AS had higher cardiac and all‐cause mortality compared with controls with CKD and no AS (P<0.001). Among patients with AS and CKD, there were 156 (19%) aortic valve replacements and 454 (54%) deaths (203 cardiac deaths) at 4.0±2.3 years of follow‐up. Lower estimated glomerular filtration rate (hazard ratio per 10 mL/min per 1.73 m2: 1.18; 95% CI, 1.08–1.29) was associated with increased risk of all‐cause mortality but not cardiac mortality (hazard ratio: 1.12; 95% CI, 0.97–1.30; P=0.13). Of patients undergoing aortic valve replacement, 61% had improvement in estimated glomerular filtration rate within 1 year (median percentage change=+2.8% per month). Conclusions Among patients with nondialysis CKD, AS is associated with significantly higher cardiac and all‐cause mortality; lower estimated glomerular filtration rate is associated with increased mortality, and aortic valve replacement was associated with improved survival. |
| first_indexed | 2024-04-13T17:01:52Z |
| format | Article |
| id | doaj.art-de79d750386c463a8936c2e18c7dc6cb |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:01:52Z |
| publishDate | 2019-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-de79d750386c463a8936c2e18c7dc6cb2022-12-22T02:38:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-02-018310.1161/JAHA.118.009980Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney DiseaseKrishna K. Patel0Shailee Y. Shah1Susana Arrigain2Stacey Jolly3Jesse D. Schold4Sankar D. Navaneethan5Brian P. Griffin6Joseph V. Nally7Milind Y. Desai8Department of Internal Medicine Cleveland Clinic Cleveland OHDepartment of Internal Medicine Cleveland Clinic Cleveland OHDepartment of Quantitative Health Sciences Cleveland Clinic Cleveland OHDepartment of Internal Medicine Cleveland Clinic Cleveland OHDepartment of Quantitative Health Sciences Cleveland Clinic Cleveland OHSection of Nephrology Department of Medicine Selzman Institute for Kidney Health Baylor College of Medicine Houston TXDepartment of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland OHGlickman Urology and Kidney Institute Cleveland Clinic Cleveland OHDepartment of Cardiovascular Medicine, Heart and Vascular Institute Cleveland Clinic Cleveland OHBackground We sought to study longer term survival in patients with aortic stenosis (AS) and nondialysis chronic kidney disease (CKD). Methods and Results We studied 839 patients (aged 78±9 years and 51% male) with CKD and AS on echocardiogram from 2005 to 2012. Longer term all‐cause and cardiovascular mortality was compared with a CKD group without AS, propensity matched for age, sex, race, left ventricular ejection fraction and CKD stage. Cox models were used to evaluate all‐cause mortality and competing‐risks regression models censored at time of aortic valve replacement to evaluate cardiac mortality in patients with AS and CKD. Overall, 511 (61%), 252 (30%), and 76 (9%) patients had CKD stages 3a, 3b, and 4, respectively; 93% had hypertension, 28% had diabetes mellitus, and 37% had coronary artery disease. In total, 185 (22%) had mild AS, 355 (42%) had moderate AS, and 299 (36%) had severe AS (66 symptomatic). Patients with CKD and AS had higher cardiac and all‐cause mortality compared with controls with CKD and no AS (P<0.001). Among patients with AS and CKD, there were 156 (19%) aortic valve replacements and 454 (54%) deaths (203 cardiac deaths) at 4.0±2.3 years of follow‐up. Lower estimated glomerular filtration rate (hazard ratio per 10 mL/min per 1.73 m2: 1.18; 95% CI, 1.08–1.29) was associated with increased risk of all‐cause mortality but not cardiac mortality (hazard ratio: 1.12; 95% CI, 0.97–1.30; P=0.13). Of patients undergoing aortic valve replacement, 61% had improvement in estimated glomerular filtration rate within 1 year (median percentage change=+2.8% per month). Conclusions Among patients with nondialysis CKD, AS is associated with significantly higher cardiac and all‐cause mortality; lower estimated glomerular filtration rate is associated with increased mortality, and aortic valve replacement was associated with improved survival.https://www.ahajournals.org/doi/10.1161/JAHA.118.009980aortic stenosischronic kidney diseasesurvival |
| spellingShingle | Krishna K. Patel Shailee Y. Shah Susana Arrigain Stacey Jolly Jesse D. Schold Sankar D. Navaneethan Brian P. Griffin Joseph V. Nally Milind Y. Desai Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic stenosis chronic kidney disease survival |
| title | Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney Disease |
| title_full | Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney Disease |
| title_fullStr | Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney Disease |
| title_full_unstemmed | Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney Disease |
| title_short | Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney Disease |
| title_sort | characteristics and outcomes of patients with aortic stenosis and chronic kidney disease |
| topic | aortic stenosis chronic kidney disease survival |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009980 |
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