Aortic stenosis and aortic valve replacement among patients with chronic kidney disease: A narrative review

Authors

Frederick Berro Rivera, Department of Medicine, Lincoln Medical Center, Bronx, New York, USA.
Maria Victoria Cu, University of the Philippines System, National Capital Region, Manila, Philippines.
Sharmaine Jesselyn Cua, University of the Philippines System, National Capital Region, Manila, Philippines.
Deogracias Villa De Luna, Department of Internal Medicine, Danbury Hospital, Danbury, Connecticut, USA.Follow
Edgar V. Lerma, Advocate Aurora Health
Peter A. McCullough, Truth for Health Foundation, Tucson, Arizona, USA.
Amir Kazory, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, Florida, USA.
Fareed Moses Collado, Department of Cardiology, Rush University Medical Center, Chicago, Illinois, USA.

Recommended Citation

Rivera FB, Cu MVV, Cua SJ, et al. Aortic Stenosis and Aortic Valve Replacement among Patients with Chronic Kidney Disease: A Narrative Review. Cardiorenal Med. 2023;13(1):74-90. doi:10.1159/000529543

Affiliations

Advocate Christ Medical Center

Abstract

Background:Aortic stenosis (AS) can present with dyspnea, angina, syncope, and palpitations, and this presents a diagnostic challenge as chronic kidney disease (CKD) and other commonly found comorbid conditions may present similarly. While medical optimization is an important aspect in management, aortic valve replacement (AVR) by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) is the definitive treatment. Patients with concomitant CKD and AS require special consideration as it is known that CKD is associated with progression of AS and poor long-term outcomes.

Aims and objectives:The aim of the study was to summarize and review the current existing literature on patients with both CKD and AS regarding disease progression, dialysis methods, surgical intervention, and postoperative outcomes.

Conclusion:The incidence of AS increases with age but has also been independently associated with CKD and furthermore with hemodialysis (HD). Regular dialysis with HD versus peritoneal dialysis (PD) and female gender have been associated with progression of AS. Management of AS is multidisciplinary and requires planning and interventions by the heart-kidney team to decrease the risk of further inducing kidney injury among high-risk population. Both TAVR and SAVR are effective interventions for patients with severe symptomatic AS, but TAVR has been associated with better short-term renal and cardiovascular outcomes.

Implications for practice:Special consideration must be given to patients with both CKD and AS. The choice of whether to undergo HD versus PD among patients with CKD is multifactorial, but studies have shown benefit regarding AS progression among those who undergo PD. The choice regarding AVR approach is likewise the same. TAVR has been associated with decreased complications among CKD patients, but the decision is multifactorial and requires a comprehensive discussion with the heart-kidney team as many other factors play a role in the decision including preference, prognosis, and other risk factors.

Document Type

Article

PubMed ID

36812906