Transcatheter aortic valve implantation versus conservative treatment in chronic kidney disease patients

Aims: There are no studies comparing transcatheter aortic valve implantation (TAVI) to conservative management in patients with chronic kidney disease stage 3-5 and severe aortic stenosis. We sought to compare the mortality rate and change in renal function in this patient population. Methods and results: This was a single-centre retrospective cohort study that included all patients with chronic kidney disease stage 3-5 and severe aortic stenosis who underwent TAVI or were treated conservatively between 2010 and 2015. Three hundred and sixty patients were included (162 TAVI and 198 conservatively treated patients). Several statistical methods were used, including propensity score matching and inverse probability weighting. Mean follow-up was 1.9 years. Conservative management was associated with a hazard ratio of 3.95 (95% CI: 2.59-6.02) for mortality compared with TAVI. After one year there was a significant decrease in renal function in the control group (39.6±13.9 ml/min to 34.4±15.3 ml/min), but not in the TAVI group (41.7±13 ml/min to 42.9±14.5 ml/min) (p-value=0.001). Conclusions: TAVI is associated with improved survival in patients with aortic stenosis and chronic kidney disease stage 3-5 compared to conservative management and protects from further decline in renal function up to one-year follow-up.