Chronic kidney disease and outcome of patients with tricuspid regurgitation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although chronic kidney disease (CKD) is common among patients with tricuspid regurgitation (TR), these patients are under-represented in clinical trials examining tricuspid transcatheter interventions, and data regarding their outcome are limited. Methods Consecutive echocardiographic reports linked to clinical data from the largest medical center in Israel (2007–2022) were reviewed. Patients were dichotomized into three groups TR groups (mild, moderate and severe), following by stratification according to renal function. The primary outcome was all-cause mortality. Kaplan Meier, Multivariate Cox regression and interaction analysis models were applied. Results The final study population included 78,461 patients with a mean age of 65 (IQR: 55–78 years), 2,998 (4%) of whom had severe TR. There were 11,443 (15%) patients with at least moderate CKD (estimated glomerular filtration rate [eGFR] < 45 mL/min/1.73 m2), 5573 (7%) with eGFR<30 and 1853 (2%) with eGFR<=15. During a median follow-up period of 4 years (IQR: 1–7 years), 28,228 patients (36%) died. Kaplan-Meier survival analysis demonstrated an increased risk for death with both increasing severity of TR and/or CKD grade (log-rank p<.001 for both;). The association of severe TR with poor survival was consistent among all CKD subgroups (FIGURE). Multivariate Cox analysis with adjustment for age, sex, ejection fraction, estimated pulmonary pressure and eGFR demonstrated that compared to mild TR, patients with severe TR were 56% more likely to die during follow up (95% CI 1.47–1.66, p<.001). Interaction analysis demonstrated that the association of severe TR degree with survival was consistent in all subgroups but dependent on renal function, such that it was more pronounced as renal function declined, with adjusted HR of 1.6 among patients with eGFR<=15 (P for intercation <.001). Conclusions While the association of TR with poor survival is consistent across all CKD groups, it is more pronounced among patients with advanced CKD. When examining data and outcome of tricuspid clinical trials, special emphasis should be given to CKD status.