Abstract 18425: Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney Disease Not on Dialysis
Introduction: We sought to study the mortality among patients with aortic stenosis (AS) &chronic kidney disease (CKD) not on dialysis, & compared them to CKD patients with no AS.
Methods: We studied 922 patients (age 78+9 years & 53% men) with CKD (2 eGFR <60ml/min at least 3 months apart) & AS on Echo 1 year prior to 2nd eGFR<60 or any time after at our centre from 2005-12. We excluded other concomitant severe valvular disease. Patients were classified into mild to severe AS. All-cause &cardiovascular survival of our AS population was compared with a CKD group without AS matched on age, gender, race and stage of CKD. We used Cox models to evaluate factors associated with all-cause mortality censored at AVR/TAVR among AS patients.
Results: At baseline, 556 (60%), 275 (30%) & 91 (10%) of the patients had CKD stage 3a, 3b, & 4 respectively. Of the patients, 205 (22%) had mild, 342 (37%) moderate & 375 (41%; 67 standard, 159 paradoxical, 58 low flow; 91 with symptoms) had severe degree of AS. 93% were hypertensives, 28% diabetic & 40% had coronary artery disease. Patients with CKD & AS had higher cardiac & all-cause mortality compared to controls with CKD and no AS (fig). At 3.3±2.4 years of follow up, there were 181 (20%) AVR/TAVR and 441 (48%) Pre-AVR Deaths (cardiac : 209). On Cox multivariable analysis, age (HR per 1 yr older 1.03 (95% CI: 1.02,1.05), male sex (HR 1.3 (1.10,1.7)), smoker (HR 1.7 (1.1,2.6)), log Alkaline phosphatase (HR per 1 log unit 1.4 (1.1,1.7)), symptomatic (HR 1.3 (1.02,1.7)), severe vs. mild AS (HR 1.5 (1.1,1.9)), & lower eGFR (HR per 1 unit 1.02 (1.01, 1.03)), were associated with higher pre-AVR death.
Conclusions: Among patients with CKD not on dialysis, presence of of AS is associated with a significantly higher cardiac and all cause mortality; lower EGFR is associated with increased mortality in these patients. Future studies are needed to help elucidate mechanisms and clinical management to help improve outcomes.
Author Disclosures: K.K. Patel: None. S. Shah: None. S. Arrigain: None. S. Jolly: None. J. Schold: None. S. Navaneethan: None. B.P. Griffin: None. J.V. Nally: None. M.Y. Desai: None.
- © 2016 by American Heart Association, Inc.