Department of Medicine, Lincoln Medical Center, Bronx, New York, USA.
University of the Philippines System, National Capital Region, Manila, Philippines.
Cardiorenal Med. 2023;13(1):74-90. doi: 10.1159/000529543. Epub 2023 Feb 22.
Aortic stenosis (AS) can present with dyspnea, angina, syncope, and palpitations, and this presents a diagnostic challenge as chronic kidney disease (CKD) and other commonly found comorbid conditions may present similarly. While medical optimization is an important aspect in management, aortic valve replacement (AVR) by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) is the definitive treatment. Patients with concomitant CKD and AS require special consideration as it is known that CKD is associated with progression of AS and poor long-term outcomes.
The aim of the study was to summarize and review the current existing literature on patients with both CKD and AS regarding disease progression, dialysis methods, surgical intervention, and postoperative outcomes.
The incidence of AS increases with age but has also been independently associated with CKD and furthermore with hemodialysis (HD). Regular dialysis with HD versus peritoneal dialysis (PD) and female gender have been associated with progression of AS. Management of AS is multidisciplinary and requires planning and interventions by the heart-kidney team to decrease the risk of further inducing kidney injury among high-risk population. Both TAVR and SAVR are effective interventions for patients with severe symptomatic AS, but TAVR has been associated with better short-term renal and cardiovascular outcomes.
Special consideration must be given to patients with both CKD and AS. The choice of whether to undergo HD versus PD among patients with CKD is multifactorial, but studies have shown benefit regarding AS progression among those who undergo PD. The choice regarding AVR approach is likewise the same. TAVR has been associated with decreased complications among CKD patients, but the decision is multifactorial and requires a comprehensive discussion with the heart-kidney team as many other factors play a role in the decision including preference, prognosis, and other risk factors.
主动脉瓣狭窄（AS）可表现为呼吸困难、心绞痛、晕厥和心悸，这给诊断带来了挑战，因为慢性肾脏病（CKD）和其他常见的合并症可能表现相似。虽然医学优化是管理的一个重要方面，但主动脉瓣置换（AVR）通过外科主动脉瓣置换（SAVR）或经导管主动脉瓣置换（TAVR）是明确的治疗方法。患有合并 CKD 和 AS 的患者需要特别考虑，因为已知 CKD 与 AS 的进展和不良的长期预后有关。
本研究的目的是总结和回顾目前关于 CKD 和 AS 患者的疾病进展、透析方法、手术干预和术后结果的现有文献。
AS 的发病率随年龄增长而增加，但也与 CKD 独立相关，并且与血液透析（HD）进一步相关。HD 与腹膜透析（PD）相比，以及女性，与 AS 的进展相关。AS 的管理是多学科的，需要心脏-肾脏团队的规划和干预，以降低高危人群进一步诱导肾脏损伤的风险。TAVR 和 SAVR 都是严重有症状 AS 患者的有效干预措施，但 TAVR 与短期肾和心血管结局的改善相关。
必须特别考虑 CKD 和 AS 并存的患者。在 CKD 患者中，选择进行 HD 还是 PD 是多因素的，但研究表明 PD 可改善 AS 进展。AVR 方法的选择也是如此。TAVR 与 CKD 患者的并发症减少有关，但该决定是多因素的，需要与心脏-肾脏团队进行全面讨论，因为许多其他因素也会影响决策，包括偏好、预后和其他风险因素。
