Elsevier

The American Journal of Cardiology

Volume 169, 15 April 2022, Pages 100-106
The American Journal of Cardiology

Transcatheter Mitral Valve Implantation In Patients With Chronic Kidney Disease

https://doi.org/10.1016/j.amjcard.2021.12.053Get rights and content

There is a paucity of data regarding the outcomes of trans-septal transcatheter mitral valve implantation (TS-TMVI) in patients with chronic kidney disease (CKD). We queried the Nationwide Readmissions Database (2015 to 2018) for patients undergoing TS-TMVI. We identified patients with CKD (Stage III or higher). We conducted propensity score matching analysis to compare the outcomes in patients with CKD versus patients without CKD. The main outcomes were in-hospital mortality and 30-day nonelective readmissions. From 2015 to 2018, there were 2,017 admissions for patients receiving TS-TMVI, of whom 733 (36.34%) had CKD. In the CKD group, 76 (10.4%) required chronic dialysis. During the study years, the number of TS-TMVI procedures increased in patients with CKD (ptrend <0.001). Patients with CKD were older and less likely to be women. There was no difference in in-hospital mortality in those with versus without CKD in the matched cohorts (7.8% vs 7.3%; odds ratio 1.09; 95% confidence interval 0.64 to 1.80). Subgroup analysis showed no interaction between chronic dialysis status and in-hospital mortality after TS-TMVI. In the matched cohort, TS-TMVI in those with CKD was associated with higher rates of cardiogenic shock (12.3% vs 7.6%, p = 0.03), acute kidney injury (35.7% vs 16.7%, p <0.001), hemodialysis (5.4% vs 1.5%, p = 0.01) and longer median length of stay, (7 [12] vs 5 [8] days, p <0.001). Patients with CKD were more likely to have 30-day nonelective readmission (25.8% vs 16.5%, p = 0.01), driven by more readmissions for bleeding/anemia. In conclusion, TS-TMVI in patients with CKD is associated with increased risk for cardiogenic shock, worsening renal function requiring hemodialysis, without increased risk of mortality when compared with patients without CKD. Also, there was a higher length of stay and 30-day readmission rate in patients with CKD versus patients without CKD.

Section snippets

Methods

This retrospective cohort study used data from the Nationwide Readmissions Database (NRD). The NRD is the largest publicly available all-payer inpatient readmission database in the United States. Unweighted, it contains approximately 18 million annual discharges from 28 states in the United States; weighted, it comprises roughly 35 million annual discharges, accounting for 58.7% of all United States hospitalizations and 59.7% of the total United States population. Patients are identified and

Results

From 2015 to 2018, there were 2,066 discharge records for patients receiving TS-TMVI. After excluding records with missing vital status (n = 3) and records with CKD stages I to II (n = 46), the final analysis included 2,017 records. Of these hospitalizations, 733 (36.34%) had CKD, and 1,284 (63.66%) did not have CKD. In the CKD group, 76 (10.4%) required chronic dialysis. During the study years, there was an increase in the uptake of TS-TMVI in patients with CKD (11 in 2015 vs 346 in 2018, p

Discussion

In the present analysis including 2,017 hospitalized patients for TS-TMVI, we evaluated the comparative short-term outcomes in those with versus without CKD. The salient study findings are as follows: (1) there was an increase in the use of TS-TMVI procedures in those with CKD during the study years; (2) there was no significant difference in in-hospital mortality after TS-TMVI in those with versus without CKD; (3) TS-TMVI in patients with CKD was associated with higher rates of cardiogenic

Disclosures

The authors have no conflicts of interest to declare.

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