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Circulation Cardiovascular Interventions
Article . 2015 . Peer-reviewed
Data sources: Crossref
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Moderate and Severe Preoperative Chronic Kidney Disease Worsen Clinical Outcomes After Transcatheter Aortic Valve Implantation

Meta-Analysis of 4992 Patients
Authors: Gargiulo G; Capodanno D; Sannino A; PERRINO, CINZIA; Capranzano P; STABILE, EUGENIO; TRIMARCO, BRUNO; +2 Authors

Moderate and Severe Preoperative Chronic Kidney Disease Worsen Clinical Outcomes After Transcatheter Aortic Valve Implantation

Abstract

Background— There is a conflicting evidence on safety and efficacy of transcatheter aortic valve implantation in patients with preoperative chronic kidney disease (CKD). Therefore, we conducted a meta-analysis on the impact of CKD on outcomes after transcatheter aortic valve implantation. Methods and Results— Nine studies including 4992 patients were analyzed. Overall preoperative CKD (stages 3–5) significantly increased early (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.08–1.94 and OR, 1.66; 95% CI, 1.04–2.67) and 1-year (OR, 1.66; 95% CI, 1.23–2.25 and OR, 1.32; 95% CI, 1.06–1.63) all-cause and cardiovascular mortality, respectively. Moderate CKD (stage 3) alone also increased early and 1-year all-cause mortality (OR, 1.43; 95% CI, 1.10–1.85 and OR, 1.41; 95% CI, 1.13–1.74). CKD stages 4 to 5 and 3 compared with stages 1 to 2 increased early stroke (OR, 2.67; 95% CI, 1.53–4.65 and OR, 1.66; 95% CI, 1.09–2.52), acute kidney injury (OR, 2.09; 95% CI, 1.17–3.72 and OR, 1.32; 95% CI, 1.09–1.60) and need for dialysis (OR, 5.92; 95% CI, 2.46–14.27 and OR, 1.55; 95% CI, 0.65–3.70), in the absence of significant differences in contrast medium administration (mean difference, −26.07; 95% CI, −53.00 to 0.85 and mean difference, −0.42; 95% CI, −16.10 to 15.26). Bleeding (life-threatening or major) was nonsignificantly increased in CKD 3 to 5 compared with CKD 1 to 2, but significantly increased in most severe patients (CKD 4–5 versus CKD 1–2: OR, 1.66; 95% CI, 1.13–2.44; CKD 4–5 versus CKD 3: OR, 1.68; 95% CI, 1.27–2.24). Conclusions— Both moderate and severe preoperative CKD significantly worsen transcatheter aortic valve implantation prognosis. Future studies on risk evaluation, prevention, and postoperative management are needed.

Country
Italy
Keywords

chronic kidney disease; prognosis; renal function; transcatheter aortic valve implantation, Heart Valve Prosthesis Implantation, Cardiac Catheterization, Chi-Square Distribution, Time Factors, chronic kidney disease ◼ prognosis ◼ renal function ◼ transcatheter aortic valve implantation, Aortic Valve Stenosis, Acute Kidney Injury, Length of Stay, Risk Assessment, Severity of Illness Index, Treatment Outcome, Renal Dialysis, Risk Factors, Disease Progression, Odds Ratio, Humans, Renal Insufficiency, Chronic

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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
69
Top 10%
Top 10%
Top 1%
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bronze