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Association of CKD with Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation.
- Source :
-
Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2017 May 08; Vol. 12 (5), pp. 718-726. Date of Electronic Publication: 2017 Mar 13. - Publication Year :
- 2017
-
Abstract
- Background and Objectives: Despitethe multiple depicted associations of CKD with reduced cardiovascular and overall prognoses, the association of CKD with outcome of patients undergoing transcatheter aortic valve implantation has still not been well described.<br />Design, Setting, Participants, & Measurements: Data from all hospitalized patients who underwent transcatheter aortic valve implantation procedures between January 1, 2010 and December 31, 2013 in Germany were evaluated regarding influence of CKD, even in the earlier stages, on morbidity, in-hospital outcomes, and costs.<br />Results: A total of 28,716 patients were treated with transcatheter aortic valve implantation. A total of 11,189 (39.0%) suffered from CKD. Patients with CKD were predominantly women; had higher rates of comorbidities, such as coronary artery disease, heart failure at New York Heart Association 3/4, peripheral artery disease, and diabetes; and had a 1.3-fold higher estimated logistic European System for Cardiac Operative Risk Evaluation value. In-hospital mortality was independently associated with CKD stage ≥3 (up to odds ratio, 1.71; 95% confidence interval, 1.35 to 2.17; P <0.05), bleeding was independently associated with CKD stage ≥4 (up to odds ratio, 1.82; 95% confidence interval, 1.47 to 2.24; P <0.001), and AKI was independently associated with CKD stages 3 (odds ratio, 1.83; 95% confidence interval, 1.62 to 2.06) and 4 (odds ratio, 2.33; 95% confidence interval, 1.92 to 2.83 both P <0.001). The stroke risk, in contrast, was lower for patients with CKD stages 4 (odds ratio, 0.23; 95% confidence interval, 0.16 to 0.33) and 5 (odds ratio, 0.24; 95% confidence interval, 0.15 to 0.39; both P <0.001). Lengths of hospital stay were, on average, 1.2-fold longer, whereas reimbursements were, on average, only 1.03-fold higher in patients who suffered from CKD.<br />Conclusions: This analysis illustrates for the first time on a nationwide basis the association of CKD with adverse outcomes in patients who underwent transcatheter aortic valve implantation. Thus, classification of CKD stages before transcatheter aortic valve implantation is important for appropriate risk stratification.<br /> (Copyright © 2017 by the American Society of Nephrology.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve physiopathology
Aortic Valve Stenosis economics
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
Chi-Square Distribution
Comorbidity
Cost-Benefit Analysis
Databases, Factual
Female
Germany epidemiology
Health Care Costs
Hospital Mortality
Humans
Insurance, Health, Reimbursement
Kidney physiopathology
Logistic Models
Male
Odds Ratio
Renal Insufficiency, Chronic economics
Renal Insufficiency, Chronic mortality
Renal Insufficiency, Chronic physiopathology
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Aortic Valve surgery
Aortic Valve Stenosis surgery
Renal Insufficiency, Chronic epidemiology
Transcatheter Aortic Valve Replacement adverse effects
Transcatheter Aortic Valve Replacement economics
Transcatheter Aortic Valve Replacement mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1555-905X
- Volume :
- 12
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Clinical journal of the American Society of Nephrology : CJASN
- Publication Type :
- Academic Journal
- Accession number :
- 28289067
- Full Text :
- https://doi.org/10.2215/CJN.10471016