Impact of atrial fibrillation in patients with chronic kidney disease undergoing transcatheter aortic valve replacement: Insights of the Healthcare Cost and Utilization Project's National Inpatient Sample.

Abstract

Limited data exists exploring the relationship between varying degrees of chronic kidney disease (CKD) and atrial fibrillation (AF) in patients undergoing transcatheter aortic valve replacement (TAVR). Records were selected from the 2011 to 2012 Healthcare Cost and Utilization Project's National Inpatient Sample for TAVR patients with pre-existing AF and CKD. Demographics, clinical characteristics, and TAVR-related in-hospital adverse events were identified and compared between patients with and without AF and moderate CKD (CKD stage 3-4), and between patients with and without AF and severe CKD (CKD stage 5 or end stage renal disease [ESRD]). Evaluated outcomes included major adverse cardiac and cerebrovascular events (MACCE). We identified a total of 293 patients with moderate CKD (stage 3 and higher) that underwent TAVR at selected U.S. hospitals between 2011 and 2012. Among these patients, 112 had a diagnosis of AF and 181 did not have AF. MACCE rates were similar among CKD 3-4 patients with and without AF (10.3% and 9.0% respectively, p=0.74). MACCE rates were similar among CKD 5/ESRD patients with and without AF (20.0% and 16.2% respectively, p=0.74). However, MACCE rates were higher in patients with CKD 5/ESRD compared with CKD 3-4 patients. Multivariate logistic regression analysis did not show that AF was an independent predictor of in-hospital MACCE. In a large retrospective analysis of CKD stage 3-4 or CKD 5/ESRD patients undergoing TAVR at selected U.S. hospitals, the presence of AF did not seem to be associated with increased adverse in-hospital events or length of stay.