Improvement of renal function after transcatheter aortic valve replacement and its impact on survival
Abstract Background Chronic kidney disease as well as acute kidney injury are associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). However, little is known about the prognostic implications of an improvement in renal function after TAVR. Methods Renal improvement (RI...
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doaj-44791d70c8994010ac9a9dc276ab3e5b2021-03-11T12:49:08ZengBMCBMC Nephrology1471-23692021-03-012211910.1186/s12882-021-02274-5Improvement of renal function after transcatheter aortic valve replacement and its impact on survivalDominik Kylies0Sandra Freitag-Wolf1Florian Fulisch2Hatim Seoudy3Christian Kuhn4Lars Philipp Kihm5Thomas Pühler6Georg Lutter7Astrid Dempfle8Norbert Frey9Thorsten Feldkamp10Derk Frank11Department of Internal Medicine IV, Nephrology and Hypertensiology, University Hospital Schleswig-HolsteinInstitute of Medical Informatics and Statistics, University Hospital Schleswig-HolsteinDepartment of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-HolsteinDepartment of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-HolsteinDepartment of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-HolsteinDepartment of Internal Medicine I, University Hospital HeidelbergDepartment of Cardiovascular Surgery, University Hospital Schleswig-HolsteinDepartment of Cardiovascular Surgery, University Hospital Schleswig-HolsteinInstitute of Medical Informatics and Statistics, University Hospital Schleswig-HolsteinDepartment of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-HolsteinDepartment of Internal Medicine IV, Nephrology and Hypertensiology, University Hospital Schleswig-HolsteinDepartment of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-HolsteinAbstract Background Chronic kidney disease as well as acute kidney injury are associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). However, little is known about the prognostic implications of an improvement in renal function after TAVR. Methods Renal improvement (RI) was defined as a decrease in postprocedural creatinine in μmol/l of ≥1% compared to its preprocedural baseline value. A propensity score representing the likelihood of RI was calculated to define patient groups which were comparable regarding potential confounders (age, sex, BMI, NYHA classification, STS score, log. EuroSCORE, history of atrial fibrillation/atrial flutter, pulmonary disease, previous stroke, CRP, creatinine, hsTNT and NT-proBNP). The cohort was stratified into 5 quintiles according to this propensity score and the survival time after TAVR was compared within each subgroup. Results Patients in quintile 5 (n = 93) had the highest likelihood for RI. They were characterized by higher creatinine, lower eGFR, higher NYHA class, higher NT-proBNP, being mostly female and having shorter overall survival time. Within quintile 5, patients without RI had significantly shorter survival compared to patients with RI (p = 0.002, HR = 0.32, 95% CI = [0.15–0.69]). There was no survival time difference between patients with and without RI in the whole cohort (p = 0.12) and in quintiles 1 to 4 (all p > 0.16). Analyses of specific subgroups showed that among patients with NYHA class IV, those with RI also had a significant survival time benefit (p < 0.001, HR = 0.15; 95%-CI = [0.05–0.44]) compared to patients without RI. Conclusions We here describe a propensity score-derived specific subgroup of patients in which RI after TAVR correlated with a significant survival benefit.https://doi.org/10.1186/s12882-021-02274-5TAVRRenal functionRenal improvementCardiorenal syndrome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Dominik Kylies Sandra Freitag-Wolf Florian Fulisch Hatim Seoudy Christian Kuhn Lars Philipp Kihm Thomas Pühler Georg Lutter Astrid Dempfle Norbert Frey Thorsten Feldkamp Derk Frank |
spellingShingle |
Dominik Kylies Sandra Freitag-Wolf Florian Fulisch Hatim Seoudy Christian Kuhn Lars Philipp Kihm Thomas Pühler Georg Lutter Astrid Dempfle Norbert Frey Thorsten Feldkamp Derk Frank Improvement of renal function after transcatheter aortic valve replacement and its impact on survival BMC Nephrology TAVR Renal function Renal improvement Cardiorenal syndrome |
author_facet |
Dominik Kylies Sandra Freitag-Wolf Florian Fulisch Hatim Seoudy Christian Kuhn Lars Philipp Kihm Thomas Pühler Georg Lutter Astrid Dempfle Norbert Frey Thorsten Feldkamp Derk Frank |
author_sort |
Dominik Kylies |
title |
Improvement of renal function after transcatheter aortic valve replacement and its impact on survival |
title_short |
Improvement of renal function after transcatheter aortic valve replacement and its impact on survival |
title_full |
Improvement of renal function after transcatheter aortic valve replacement and its impact on survival |
title_fullStr |
Improvement of renal function after transcatheter aortic valve replacement and its impact on survival |
title_full_unstemmed |
Improvement of renal function after transcatheter aortic valve replacement and its impact on survival |
title_sort |
improvement of renal function after transcatheter aortic valve replacement and its impact on survival |
publisher |
BMC |
series |
BMC Nephrology |
issn |
1471-2369 |
publishDate |
2021-03-01 |
description |
Abstract Background Chronic kidney disease as well as acute kidney injury are associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). However, little is known about the prognostic implications of an improvement in renal function after TAVR. Methods Renal improvement (RI) was defined as a decrease in postprocedural creatinine in μmol/l of ≥1% compared to its preprocedural baseline value. A propensity score representing the likelihood of RI was calculated to define patient groups which were comparable regarding potential confounders (age, sex, BMI, NYHA classification, STS score, log. EuroSCORE, history of atrial fibrillation/atrial flutter, pulmonary disease, previous stroke, CRP, creatinine, hsTNT and NT-proBNP). The cohort was stratified into 5 quintiles according to this propensity score and the survival time after TAVR was compared within each subgroup. Results Patients in quintile 5 (n = 93) had the highest likelihood for RI. They were characterized by higher creatinine, lower eGFR, higher NYHA class, higher NT-proBNP, being mostly female and having shorter overall survival time. Within quintile 5, patients without RI had significantly shorter survival compared to patients with RI (p = 0.002, HR = 0.32, 95% CI = [0.15–0.69]). There was no survival time difference between patients with and without RI in the whole cohort (p = 0.12) and in quintiles 1 to 4 (all p > 0.16). Analyses of specific subgroups showed that among patients with NYHA class IV, those with RI also had a significant survival time benefit (p < 0.001, HR = 0.15; 95%-CI = [0.05–0.44]) compared to patients without RI. Conclusions We here describe a propensity score-derived specific subgroup of patients in which RI after TAVR correlated with a significant survival benefit. |
topic |
TAVR Renal function Renal improvement Cardiorenal syndrome |
url |
https://doi.org/10.1186/s12882-021-02274-5 |
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