Clinical profile and outcomes in patients with moderate to severe aortic stenosis with or without concomitant chronic kidney disease

• Published in: Singapore medical journal Vol. 65; no. 11; pp. 624 - 630
• Main Authors: Ngiam, Jinghao Nicholas, Sia, Ching-Hui, Chew, Nicholas Wen Sheng, Liong, Tze Sian, Chang, Zi Yun, Lee, Chi Hang, Ruan, Wen, Tay, Edgar Lik-Wui, Kong, William Kok-Fai, Tan, Huay Cheem, Yeo, Tiong-Cheng, Poh, Kian Keong
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer - Medknow 01.11.2024
• Subjects: Aged; Aged, 80 and over; Aortic Valve - surgery; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - surgery; Echocardiography; Echocardiography, Doppler; Female; Glomerular Filtration Rate; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Original; Proportional Hazards Models; Renal Insufficiency, Chronic - complications; Retrospective Studies; Severity of Illness Index
• DOI: 10.4103/singaporemedj.SMJ-2021-427
• ISSN: 0037-5675

Management of aortic stenosis (AS) in patients with chronic kidney disease (CKD) may often be overlooked, and this could confer poorer outcomes. Consecutive patients ( n = 727) with index echocardiographic diagnosis of moderate to severe AS (aortic valve area <1.5 cm 2 ) were examined. They were divided into those with CKD (estimated glomerular filtration rate < 60 mL/min) and those without. Baseline clinical and echocardiographic parameters were compared, and a multivariate Cox regression model was constructed. Clinical outcomes were compared using Kaplan-Meier curves. There were 270 (37.1%) patients with concomitant CKD. The CKD group was older (78.0 ± 10.3 vs. 72.1 ± 12.9 years, P < 0.001), with a higher prevalence of hypertension, diabetes mellitus, hyperlipidaemia and ischaemic heart disease. AS severity did not differ significantly, but left ventricular (LV) mass index (119.4 ± 43.7 vs. 112.3 ± 40.6 g/m 2 , P = 0.027) and Doppler mitral inflow E to annular tissue Doppler e' ratio (E: e' 21.5 ± 14.6 vs. 17.8 ± 12.2, P = 0.001) were higher in the CKD group. There was higher mortality (log-rank 51.5, P < 0.001) and more frequent admissions for cardiac failure (log-rank 25.9, P < 0.001) in the CKD group, with a lower incidence of aortic valve replacement (log-rank 7.12, P = 0.008). On multivariate analyses, after adjusting for aortic valve area, age, left ventricular ejection fraction and clinical comorbidities, CKD remained independently associated with mortality (hazard ratio 1.96, 95% confidence interval 1.50-2.57, P < 0.001). Concomitant CKD in patients with moderate to severe AS was associated with increased mortality, more frequent admissions for cardiac failure and a lower incidence of aortic valve replacement.