Characteristics and outcomes of patients with aortic stenosis and chronic kidney disease

Background-—We sought to study longer term survival in patients with aortic stenosis (AS) and nondialysis chronic kidney disease (CKD). Methods and Results-—We studied 839 patients (aged 78-9 years and 51% male) with CKD and AS on echocardiogram from 2005 to 2012. Longer term all-cause and cardiovascular mortality was compared with a CKD group without AS, propensity matched for age, sex, race, left ventricular ejection fraction and CKD stage. Cox models were used to evaluate all-cause mortality and competing-risks regression models censored at time of aortic valve replacement to evaluate cardiac mortality in patients with AS and CKD. Overall, 511 (61%), 252 (30%), and 76 (9%) patients had CKD stages 3a, 3b, and 4, respectively; 93% had hypertension, 28% had diabetes mellitus, and 37% had coronary artery disease. In total, 185 (22%) had mild AS, 355 (42%) had moderate AS, and 299 (36%) had severe AS (66 symptomatic). Patients with CKD and AS had higher cardiac and all-cause mortality compared with controls with CKD and no AS (P<0.001). Among patients with AS and CKD, there were 156 (19%) aortic valve replacements and 454 (54%) deaths (203 cardiac deaths) at 4.0±2.3 years of follow-up. Lower estimated glomerular filtration rate (hazard ratio per 10 mL/min per 1.73 m²: 1.18; 95% CI, 1.08–1.29) was associated with increased risk of all-cause mortality but not cardiac mortality (hazard ratio: 1.12; 95% CI, 0.97–1.30; P=0.13). Of patients undergoing aortic valve replacement, 61% had improvement in estimated glomerular filtration rate within 1 year (median percentage change=+2.8% per month). Conclusions-—Among patients with nondialysis CKD, AS is associated with significantly higher cardiac and all-cause mortality; lower estimated glomerular filtration rate is associated with increased mortality, and aortic valve replacement was associated with improved survival.