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Abstract: PO2076

Temporal Trends of the Burden of CKD Among Hospitalized Aortic Stenosis Patients in the Province of Quebec, Canada

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Khelifi, Nada, CHU de Québec Research Center, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
  • Hamel, Denis, Institut national de santé publique du Québec, Québec, Quebec, Canada
  • Jean, Sonia, Institut national de santé publique du Québec, Québec, Quebec, Canada
  • Blais, Claudia, Institut national de santé publique du Québec, Québec, Quebec, Canada
  • Mac-Way, Fabrice, CHU de Québec Research Center, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
Background

Aortic stenosis (AS) is associated with valvular calcifications which are highly prevalent in chronic kidney disease (CKD). The aim of this study was to describe the temporal trends of comorbid CKD status in patients hospitalized for AS and evaluate the impact of these two conditions on 1-year mortality in the province of Quebec, between 2000 and 2017.

Methods

Using the Quebec Integrated Chronic Disease Surveillance System, we identified patients ≥ 20 years with incident AS using ICD-9 and ICD-10 codes, in the hospital discharge database. We then combined hospital discharges and physician billing claims databases to identify patients with comorbid CKD status in the two years prior to the AS diagnosis. Three subgroups of CKD status were considered: 1) non-CKD, 2) pre-dialysis and 3) dialysis. To allow comparison over time, direct adjustment using age distribution of the 2016-2017 AS population was used for proportion, 1-year all-cause and cardiovascular mortality.

Results

We included 108,780 patients with incident AS (Women: 51.8%; mean age (±SD): 76.4 ±11.7; non-CKD: 74.2% (n=80,768); pre-dialysis: 24.6% (n=26,809); dialysis: 1.1% (n=1,203). During the study period, the age-adjusted proportion of AS patients with non-CKD comorbid status decreased by 14% (80.7% [95% CI 77.6-84.0] to 69.6% [95% CI 67.2-71.9]). Inversely, the age-adjusted proportion of AS patients with pre-dialysis and dialysis comorbid status increased by 58% (18.5% [95% CI 16.9-20.2] to 29.3% [95% CI 27.8-30.9]) and 46% (0.76% [95% CI 0.5-1.1] to 1.1% [95% CI 0.8-1.4]), respectively. Age-adjusted 1-year all-cause and cardiovascular mortality decreased over time but remained higher in patients with comorbid CKD. In 2015-2016, age-adjusted relative risk (RR) of 1-year all-cause mortality was significantly higher in pre-dialysis (RR=1.56 [95% CI 1.44, 1.69]) and dialysis (RR=2.04 [95% CI 1.62-2.61]) compared to non-CKD patients. Age-adjusted RR of 1-year cardiovascular mortality was also significantly higher in pre-dialysis (RR=1.83 [95% CI 1.66-2.03]) and dialysis (RR=2.28 [95% CI 1.68-3.09]) compared to non-CKD patients.

Conclusion

Proportion of patients with incident AS and comorbid CKD increased from 2000 to 2017. One-year all-cause and cardiovascular mortality improved over time but remained higher in AS patients with comorbid CKD.