Abstract: FR-PO485

Impact of Transcatheter Aortic Valve Implantation on Renal Function

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Calça, Rita, Hospital Santa Cruz, Lisboa, Portugal
  • Weigert, Andre L., Hospital Santa Cruz, Lisboa, Portugal
  • Teles, Rui C, Hospital Santa Cruz, Lisboa, Portugal
  • Branco, Patricia Quadros, Hospital Santa Cruz, Lisboa, Portugal
  • Brito, João, Hospital Santa Cruz, Lisboa, Portugal
  • Nolasco, Tiago, Hospital Santa Cruz, Lisboa, Portugal
  • Almeida, Manuel De sousa, Hospital Santa Cruz, Lisboa, Portugal
  • Neves, José Pedro, Hospital Santa Cruz, Lisboa, Portugal
  • Mendes, Miguel, Hospital Santa Cruz, Lisboa, Portugal
  • Machado, Domingos Silveira, Hospital Santa Cruz, Lisboa, Portugal
Background

Chronic kidney disease (CKD) is very prevalent in patients with aortic valve disease. Decreased renal perfusion as a consequence of diminished cardiac output may contribute to this patient's renal disfuncion. Given the potential reversibility of this mechanism after valve correction, the aim of this study was to verify the impact of percutaneous transcatether aortic implantation (TAVI) on kidney function.

Methods

We performed a retrospective analysis of 233 consecutive patients that underwent TAVI and were included in single center prospective registry between November 2008 and May 2017. Estimated Glomerular Filtration Rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and we considered 3 groups according their eGFR (mL/min/1.73 m2); the categories sugested by Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines were mentioned for each group. Group 1 with eGFR≥60 included patients without CKD or CKD G1-2; Group 2 with 30≤eGFR<60 (CKD G3a-b); and Group 3 with eGFR<30 (CKD G4). Patients on dialysis were excluded from the analysis. Previous to TAVI, 43,1% were in Group 1, 44,0% in Group 2 and the remaining 12,9% in Group 3.

Results

56.7% were female and the mean age was 81.8±7.5years (from 47 to 94years). No age or gender differences were found between groups. In patients from Group 1, a 15% fall in eGFR was verified after 1year follow-up (table1). Conversely, in patients from Group 2 and Group 3 we observed a significant increase in eGFR after TAVI (table1).

Conclusion

The association between worse outcomes in CKD patients undergoing TAVI is well established, but little is known about the potential reversibility of renal function after aortic valve replacement. We concluded that, for patients with moderate-to-severe CKD, there is a gain of function in the first month post-TAVI, which increased further 1 year after the procedure. This is probably due to improved renal perfusion post-procedure. We postulate that when evaluating patients that might need TAVI, this ‘reversibility of CKD effect’ should be considered.

Table 1
 eGFR pre-TAVI (mL/min/1.73m2)eGFR 1month after TAVI (mL/min/1.73 m2)eGFR 1 year after TAVI (mL/min/1.73 m2)p value
Group 174,9±9,065,6±20,063,4 ±19,2<0.001
Group 245,4±8,550,1±15,152,6±16,4<0.01
Group 324,4±5,134,9±18,138,4±18,8<0.01