Al Jarallah Mohammed, Abdulsalam Salman, Rajan Rajesh, Dashti Raja, Zhanna Kobalava D, Setiya Parul, Al-Saber Ahmad, Alajmi Mohammad, Brady Peter A, Luisa Baca Georgiana, Al Balool Joud, Tse Gary
Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait.
Faculty of Medicine, Royal College of Surgeons Ireland, Dublin, Ireland.
Ann Med Surg (Lond). 2023 Dec 5;86(2):697-702. doi: 10.1097/MS9.0000000000001590. eCollection 2024 Feb.
Chronic kidney disease (CKD) is a common comorbid condition in patients undergoing transcatheter aortic valve replacement (TAVR). Reported outcome studies on the association of baseline CKD and mortality is currently limited.
To determine the prevalence of chronic kidney disease in patients undergoing TAVR and analyse their overall procedural outcomes.
This retrospective observational study was conducted at 43 publicly funded hospitals in Hong Kong. Severe aortic stenosis patients undergoing TAVR between the years 2010 and 2019 were enroled in the study. Two groups were identified according to the presence of baseline chronic kidney disease.
A total of 499 patients (228, 58.6% men) were enroled in the study. Baseline hypertension was more prevalent in patients with CKD (82.8%; =0.003). As for primary end-points, mortality rates of CKD patients were significantly higher compared to non-CKD patients (10% vs. 4.1%; =0.04%). Gout and hypertension were found to be significantly associated with CRF. Patients with gout were nearly six times more likely to have CRF than those without gout (odds ratio = 5.96, 95% CI = 3.12-11.29, <0.001). Patients with hypertension had three times the likelihood of having CRF compared to those without hypertension (odds ratio=2.83, 95% CI=1.45-6.08, =0.004).
In patients with severe aortic stenosis undergoing TAVR, baseline CKD significantly contributes to mortality outcomes at long-term follow up.
慢性肾脏病（CKD）是经导管主动脉瓣置换术（TAVR）患者中常见的合并症。目前关于基线CKD与死亡率之间关联的结局研究报道有限。
确定接受TAVR患者中慢性肾脏病的患病率，并分析其总体手术结局。
这项回顾性观察性研究在香港43家公立医院进行。纳入2010年至2019年间接受TAVR的重度主动脉瓣狭窄患者。根据基线慢性肾脏病的存在情况确定两组。
共有499例患者（228例，58.6%为男性）纳入研究。CKD患者中基线高血压更为普遍（82.8%；P=0.003）。至于主要终点，CKD患者的死亡率显著高于非CKD患者（10%对4.1%；P=0.04%）。发现痛风和高血压与慢性肾衰竭显著相关。有痛风的患者发生慢性肾衰竭的可能性是非痛风患者的近6倍（比值比=5.96，95%置信区间=3.12-11.29，P<0.001）。有高血压的患者发生慢性肾衰竭的可能性是无高血压患者的3倍（比值比=2.83，95%置信区间=1.45-6.08，P=0.004）。
在接受TAVR的重度主动脉瓣狭窄患者中，基线CKD在长期随访中显著影响死亡率结局。
