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Impact of renal dysfunction on mid-term outcome after transcatheter aortic valve implantation: a systematic review and meta-analysis.

Chen C, Zhao ZG, Liao YB, Peng Y, Meng QT, Chai H, Li Q, Luo XL, Liu W, Zhang C, Chen M, Huang DJ - PLoS ONE (2015)

Bottom Line: Patients with CKD stage 4 had a higher incidence of AKI (univariate HR: 1.70, 95% CI: 1.34-2.16) and all-cause death (univariate HR: 1.60, 95% CI: 1.28-1.99) compared with those with CKD stage 3.Preexisting RD was associated with increased mid-term mortality after TAVI.Patients with CKD stage 4 had significantly higher incidences of peri-procedural complications and a poorer prognosis, a finding that should be factored into the clinical decision-making process regarding these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China.

ABSTRACT

Background: There is conflicting evidence regarding the impact of preexisting renal dysfunction (RD) on mid-term outcomes after transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis (AS).

Methods and results: Forty-seven articles representing 32,131 patients with AS undergoing a TAVI procedure were included in this systematic review and meta-analysis. Pooled analyses were performed with both univariate and multivariate models, using a fixed or random effects method when appropriate. Compared with patients with normal renal function, mid-term mortality was significantly higher in patients with preexisting RD, as defined by the author (univariate hazard ratio [HR]: 1.69; 95% confidence interval [CI]: 1.50-1.90; multivariate HR: 1.47; 95% CI: 1.17-1.84), baseline estimated glomerular filtration rate (eGFR) (univariate HR: 1.65; 95% CI: 1.47-1.86; multivariate HR: 1.46; 95% CI: 1.24-1.71), and serum creatinine (univariate HR: 1.69; 95% CI: 1.48-1.92; multivariate HR: 1.65; 95% CI: 1.36-1.99). Advanced stage of chronic kidney disease (CKD stage 3-5) was strongly related to bleeding (univariate HR in CKD stage 3: 1.30, 95% CI: 1.13-1.49; in CKD stage 4: 1.30, 95% CI: 1.04-1.62), acute kidney injure (AKI) (univariate HR in CKD stage 3: 1.28, 95% CI: 1.03-1.59; in CKD stage 4: 2.27, 95% CI: 1.74-2.96), stroke (univariate HR in CKD stage 4: 3.37, 95% CI: 1.52-7.46), and mid-term mortality (univariate HR in CKD stage 3: 1.57, 95% CI: 1.26-1.95; in CKD stage 4: 2.77, 95% CI: 2.06-3.72; in CKD stage 5: 2.64, 95% CI: 1.91-3.65) compared with CKD stage 1+2. Patients with CKD stage 4 had a higher incidence of AKI (univariate HR: 1.70, 95% CI: 1.34-2.16) and all-cause death (univariate HR: 1.60, 95% CI: 1.28-1.99) compared with those with CKD stage 3. A per unit decrease in serum creatinine was also associated with a higher mortality at mid-term follow-up (univariate HR: 1.24, 95% CI: 1.18-1.30; multivariate HR: 1.19, 95% CI: 1.08-1.30).

Conclusions: Preexisting RD was associated with increased mid-term mortality after TAVI. Patients with CKD stage 4 had significantly higher incidences of peri-procedural complications and a poorer prognosis, a finding that should be factored into the clinical decision-making process regarding these patients.

No MeSH data available.


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Forest plots of peri-procedural complications associated with RD.A, Pooled univariate hazard ratio of patients without RD compared with patients with RD for all-cause bleeding. B, Pooled univariate hazard ratio of patients without RD compared with patients with RD for major vascular complications. C, Pooled univariate hazard ratio of patients without RD compared with patients with RD for acute kidney injure. D, Pooled univariate hazard ratio of patients without RD compared with patients with RD for stroke. RD, renal dysfunction; CI, confidence interval; Fixed, fixed-effects model; IV, Generic Inverse Variance method.
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pone.0119817.g005: Forest plots of peri-procedural complications associated with RD.A, Pooled univariate hazard ratio of patients without RD compared with patients with RD for all-cause bleeding. B, Pooled univariate hazard ratio of patients without RD compared with patients with RD for major vascular complications. C, Pooled univariate hazard ratio of patients without RD compared with patients with RD for acute kidney injure. D, Pooled univariate hazard ratio of patients without RD compared with patients with RD for stroke. RD, renal dysfunction; CI, confidence interval; Fixed, fixed-effects model; IV, Generic Inverse Variance method.

Mentions: Compared with patients with CKD stage 1+2, patients with advanced CKD had significantly higher incidences of all-cause bleeding (univariate HR in CKD stage 3: 1.30, 95% CI: 1.13–1.49; in CKD stage 4: 1.30, 95% CI: 1.04–1.62), post-procedural AKI (univariate HR in CKD stage 3: 1.28, 95% CI: 1.03–1.59; in CKD stage 4: 2.27, 95% CI: 1.74–2.96), and stroke (univariate HR in CKD stage 4: 3.37, 95% CI: 1.52–7.46). Major vascular complications (MVC) were without significant difference according to baseline renal function status (Fig. 5). Compared with CKD stage 3, CKD stage 4 was strongly related to a higher incidence of AKI ((univariate HR: 1.70, 95% CI: 1.34–2.16), however, this difference was not significant when focusing on bleeding or stroke (Fig. 6). Sensitivity analyses were not conducted due to the small number of studies in each groups.


Impact of renal dysfunction on mid-term outcome after transcatheter aortic valve implantation: a systematic review and meta-analysis.

Chen C, Zhao ZG, Liao YB, Peng Y, Meng QT, Chai H, Li Q, Luo XL, Liu W, Zhang C, Chen M, Huang DJ - PLoS ONE (2015)

Forest plots of peri-procedural complications associated with RD.A, Pooled univariate hazard ratio of patients without RD compared with patients with RD for all-cause bleeding. B, Pooled univariate hazard ratio of patients without RD compared with patients with RD for major vascular complications. C, Pooled univariate hazard ratio of patients without RD compared with patients with RD for acute kidney injure. D, Pooled univariate hazard ratio of patients without RD compared with patients with RD for stroke. RD, renal dysfunction; CI, confidence interval; Fixed, fixed-effects model; IV, Generic Inverse Variance method.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4368625&req=5

pone.0119817.g005: Forest plots of peri-procedural complications associated with RD.A, Pooled univariate hazard ratio of patients without RD compared with patients with RD for all-cause bleeding. B, Pooled univariate hazard ratio of patients without RD compared with patients with RD for major vascular complications. C, Pooled univariate hazard ratio of patients without RD compared with patients with RD for acute kidney injure. D, Pooled univariate hazard ratio of patients without RD compared with patients with RD for stroke. RD, renal dysfunction; CI, confidence interval; Fixed, fixed-effects model; IV, Generic Inverse Variance method.
Mentions: Compared with patients with CKD stage 1+2, patients with advanced CKD had significantly higher incidences of all-cause bleeding (univariate HR in CKD stage 3: 1.30, 95% CI: 1.13–1.49; in CKD stage 4: 1.30, 95% CI: 1.04–1.62), post-procedural AKI (univariate HR in CKD stage 3: 1.28, 95% CI: 1.03–1.59; in CKD stage 4: 2.27, 95% CI: 1.74–2.96), and stroke (univariate HR in CKD stage 4: 3.37, 95% CI: 1.52–7.46). Major vascular complications (MVC) were without significant difference according to baseline renal function status (Fig. 5). Compared with CKD stage 3, CKD stage 4 was strongly related to a higher incidence of AKI ((univariate HR: 1.70, 95% CI: 1.34–2.16), however, this difference was not significant when focusing on bleeding or stroke (Fig. 6). Sensitivity analyses were not conducted due to the small number of studies in each groups.

Bottom Line: Patients with CKD stage 4 had a higher incidence of AKI (univariate HR: 1.70, 95% CI: 1.34-2.16) and all-cause death (univariate HR: 1.60, 95% CI: 1.28-1.99) compared with those with CKD stage 3.Preexisting RD was associated with increased mid-term mortality after TAVI.Patients with CKD stage 4 had significantly higher incidences of peri-procedural complications and a poorer prognosis, a finding that should be factored into the clinical decision-making process regarding these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China.

ABSTRACT

Background: There is conflicting evidence regarding the impact of preexisting renal dysfunction (RD) on mid-term outcomes after transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis (AS).

Methods and results: Forty-seven articles representing 32,131 patients with AS undergoing a TAVI procedure were included in this systematic review and meta-analysis. Pooled analyses were performed with both univariate and multivariate models, using a fixed or random effects method when appropriate. Compared with patients with normal renal function, mid-term mortality was significantly higher in patients with preexisting RD, as defined by the author (univariate hazard ratio [HR]: 1.69; 95% confidence interval [CI]: 1.50-1.90; multivariate HR: 1.47; 95% CI: 1.17-1.84), baseline estimated glomerular filtration rate (eGFR) (univariate HR: 1.65; 95% CI: 1.47-1.86; multivariate HR: 1.46; 95% CI: 1.24-1.71), and serum creatinine (univariate HR: 1.69; 95% CI: 1.48-1.92; multivariate HR: 1.65; 95% CI: 1.36-1.99). Advanced stage of chronic kidney disease (CKD stage 3-5) was strongly related to bleeding (univariate HR in CKD stage 3: 1.30, 95% CI: 1.13-1.49; in CKD stage 4: 1.30, 95% CI: 1.04-1.62), acute kidney injure (AKI) (univariate HR in CKD stage 3: 1.28, 95% CI: 1.03-1.59; in CKD stage 4: 2.27, 95% CI: 1.74-2.96), stroke (univariate HR in CKD stage 4: 3.37, 95% CI: 1.52-7.46), and mid-term mortality (univariate HR in CKD stage 3: 1.57, 95% CI: 1.26-1.95; in CKD stage 4: 2.77, 95% CI: 2.06-3.72; in CKD stage 5: 2.64, 95% CI: 1.91-3.65) compared with CKD stage 1+2. Patients with CKD stage 4 had a higher incidence of AKI (univariate HR: 1.70, 95% CI: 1.34-2.16) and all-cause death (univariate HR: 1.60, 95% CI: 1.28-1.99) compared with those with CKD stage 3. A per unit decrease in serum creatinine was also associated with a higher mortality at mid-term follow-up (univariate HR: 1.24, 95% CI: 1.18-1.30; multivariate HR: 1.19, 95% CI: 1.08-1.30).

Conclusions: Preexisting RD was associated with increased mid-term mortality after TAVI. Patients with CKD stage 4 had significantly higher incidences of peri-procedural complications and a poorer prognosis, a finding that should be factored into the clinical decision-making process regarding these patients.

No MeSH data available.


Related in: MedlinePlus