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Observational Study
. 2017 Jul 14;6(7):e004961.
doi: 10.1161/JAHA.116.004961.

Severe Aortic Stenosis in Dialysis Patients

Yuichi Kawase  1 , Tomohiko Taniguchi  2 , Takeshi Morimoto  3 , Kazushige Kadota  1 , Keiichiro Iwasaki  1 , Akimune Kuwayama  1 , Masanobu Ohya  1 , Takenobu Shimada  1 , Hidewo Amano  1 , Takeshi Maruo  1 , Yasushi Fuku  1 , Chisato Izumi  4 , Takeshi Kitai  5 , Naritatsu Saito  2 , Eri Minamino-Muta  2 , Takao Kato  2 , Tsukasa Inada  6 , Moriaki Inoko  7 , Katsuhisa Ishii  8 , Tatsuhiko Komiya  9 , Michiya Hanyu  10 , Kenji Minatoya  11 , Takeshi Kimura  12 ; CURRENT AS Registry Investigators
Affiliations
Observational Study

Severe Aortic Stenosis in Dialysis Patients

Yuichi Kawase et al. J Am Heart Assoc. .

Abstract

Background: Characteristics and prognosis of hemodialysis patients with severe aortic stenosis have not yet been well defined.

Methods and results: The CURRENT AS (contemporary outcomes after surgery and medical treatment in patients with severe aortic stenosis) registry, a Japanese multicenter registry, enrolled 3815 consecutive patients with severe aortic stenosis. There were 405 hemodialysis patients (initial aortic valve replacement [AVR] group: N=135 [33.3%], and conservative group: N=270) and 3410 nonhemodialysis patients (initial AVR group: N=1062 [31.1%], and conservative group: N=2348). The median follow-up duration after the index echocardiography was 1361 days, with 90% follow-up rate at 2 years. The cumulative 5-year incidence of all-cause death was significantly higher in hemodialysis patients than in nonhemodialysis patients in both the entire cohort (71% versus 40%, P<0.001) and in the initial AVR group (63.2% versus 17.9%, P<0.001). Among hemodialysis patients, the initial AVR group as compared with the conservative group was associated with significantly lower cumulative 5-year incidences of all-cause death (60.6% versus 75.5%, P<0.001) and sudden death (10.2% versus 31.7%, P<0.001). Nevertheless, the rate of aortic valve procedure-related death, which predominantly occurred within 6 months of the AVR procedure, was markedly higher in the hemodialysis patients than in the nonhemodialysis patients (21.2% and 2.3%, P<0.001).

Conclusions: Among hemodialysis patients with severe aortic stenosis, the initial AVR strategy as compared with the conservative strategy was associated with significantly lower long-term mortality risk, particularly the risk for sudden death, although the effect size for the survival benefit of the initial AVR strategy was smaller than that in the nonhemodialysis patients.

Keywords: aortic stenosis; hemodialysis; prognosis.

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Figures

Figure 1
Figure 1
Study flow chart. AS indicates aortic stenosis; AVR, aortic valve replacement.
Figure 2
Figure 2
Cumulative incidence of surgical AVR or TAVI: dialysis vs nondialysis patients. Follow‐up was commenced on the day of the index echocardiography. AVR indicates aortic valve replacement; TAVI, transcatheter aortic valve implantation.
Figure 3
Figure 3
Cumulative incidence of all‐cause death and sudden death: dialysis vs nondialysis patients. Follow‐up was commenced on the day of the index echocardiography.
Figure 4
Figure 4
Cumulative incidence of all‐cause death (A) and sudden death (B) in dialysis patients and nondialysis patients: initial AVR vs conservative strategies. Follow‐up was commenced on the day of the index echocardiography. AVR indicates aortic valve replacement.
Figure 5
Figure 5
Cumulative incidence of all‐cause death and aortic valve procedure–related death after surgical AVR/TAVI in the initial AVR group: dialysis vs nondialysis patients. In the initial AVR group, 1174 of 1197 patients actually underwent surgical AVR or TAVI. Follow‐up was commenced on the day of surgical AVR or TAVI. AVR indicates aortic valve replacement; TAVI, transcatheter aortic valve implantation.
See this image and copyright information in PMC

References

    1. US Renal Data System: USRDS 2014 Annual Data Report. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2014.
    1. Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, Wakai T, Wada A, Nitta K. An overview of regular dialysis treatment in Japan (As of December 31, 2014) [Japanese]. J Jpn Soc Dial Ther. 2016;49:1‐34. - PubMed
    1. Straumann E, Meyer B, Misteli M, Blumberg A, Jenzer HR. Aortic and mitral valve disease in patients with end stage renal failure on long‐term haemodialysis. Br Heart J. 1992;67:236–239. - PMC - PubMed
    1. Ohara T, Hashimoto Y, Matsumura A, Suzuki M, Isobe M. Accelerated progression and morbidity in patients with aortic stenosis on chronic dialysis. Circ J. 2005;69:1535–1539. - PubMed
    1. Hoshina M, Wada H, Sakakura K, Kubo N, Ikeda N, Sugawara Y, Yasu T, Ako J, Momomura S. Determinants of progression of aortic valve stenosis and outcome of adverse events in hemodialysis patients. J Cardiol. 2012;59:78–83. - PubMed

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