Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta-analysis

Abstract

© 2019 Wiley Periodicals, Inc. Objective: We performed a systematic review and meta-analysis to explore the association between chronic kidney disease (CKD) and mortality and procedural complications in transcatheter aortic valve replacement (TAVR). Background: The impact of varying stages of CKD or end-stage renal disease (ESRD) on patients receiving TAVR is not clearly identified. Methods: We searched the databases of MEDLINE and EMBASE from inception to May 2018. Included studies were published TAVR studies that compared the risk of mortality and procedural complications in CKD patients compared to control patients. Data from each study were combined using the random-effects model. Results: Twelve studies (42,703 CKD patients and 51,347 controls) were included. Compared with controls, CKD patients had a significantly higher risk of 30-day overall mortality (risk ratio [RR] = 1.56, 95% confidence interval [CI]: 1.34–1.80, I2 = 60.9), long-term cardiovascular mortality (RR = 1.44, 95% CI: 1.22–1.70, I2 = 36.2%), and long-term overall mortality (RR = 1.66, 95% CI: 1.45–1.91, I2 = 80.3), as well as procedural complications including pacemaker requirement (RR = 1.20, 95% CI: 1.03–1.39, I2 = 56.1%) and bleeding (RR = 1.60, 95% CI: 1.26–2.02, I2 = 86.0%). Risk of mortality and procedural complications increased with severity of CKD for stages 3, 4, and 5, respectively, in terms of long-term overall mortality (RR = 1.28, 1.82, and 2.12), 30-day overall mortality (RR = 1.26, 1.89, and 1.93), 30-day cardiovascular mortality (RR = 1.18, 1.75, and 2.50), and 30-day overall bleeding (RR = 1.19, 1.63, and 2.12). Conclusions: Our meta-analysis demonstrates a significant increased risk of mortality and procedural complications in patients with CKD who underwent TAVR compared to controls.