Kidney Function Change after Transcatheter Aortic Valve Replacement in Patients with Diabetes and/or Hypertension

Abstract Background The kidney function change after Transcatheter Aortic Valve Replacement (TAVR) in diabetes and/or hypertension patients is currently unknown. Methods A total of 242 severe Aortic Stenosis patients with diabetes mellitus and/or hypertension who underwent TAVR were analyzed. Patients were categorized into 3 groups based on the percent change [(discharge eGFR – baseline eGFR) x 100/baseline eGFR] in eGFR: improved ≥ 10%, no change, and declined ≥ 10%. Results Of these patients, 93 (38.4%) had an improvement in eGFR ≥ 10%, 117 (48.3%) had no changes, and 32 (13.2%) had a decline in eGFR of more than 10%. Patients with unchanged kidney function may be with lower STS scores (5.09 [3.58–8.34] % vs. 7.04 [4.52–9.91] % vs. 7.41 [3.52–10.97] %, p = 0.003), and lower perivascular disease (14.5% vs. 26.9% vs. 40.6%, p = 0.003) when compared with improved and declined kidney function patients, respectively. Patients with improved kidney function had lower eGFR (45.0 [33.9–60.3] mL/min/1.73 m2 vs. 57.4 [43.4–70.7] mL/min/1.73 m2 vs. 56.6 [44.2–76.8] mL/min/1.73 m2, p = 0.000), and lower LVEF (55.1 [40.9–62.0] % vs. 60.4 [53.4–66.1] % vs. 59.9 [52.9–67.8] %, p = 0.002) than the unchanged or declined group, respectively. Moreover, patients with worsening kidney function had higher rate of in-hospital (12.5% vs. 1.7% vs. 0%, p = 0.002) and 30-day (15.6% vs. 1.7% vs. 0%, p = 0.000) mortality. Independent predictors of eGFR changes were STS scores, LVEF, baseline eGFR, and unplanned cardiopulmonary bypass. Conclusions Nearly 40% of diabetic and/or hypertensive patients experience an intermediate improvement after TAVR. Patients with declining renal function suffer more terrible outcomes in mortality.