Background: Pre-existing chronic kidney disease (CKD) portends adverse outcomes
following heart valve surgery. However, only limited and conflicting evidence is available on the
impact of CKD on outcomes following transcatheter aortic valve replacement (TAVR). The
objective of this review was to evaluate the effect of pre-existing CKD on TAVR outcomes.
Methods: We performed a systematic electronic search using the PRISMA statement to identify all
randomized controlled trials and observational studies investigating the effect of pre-existing CKD
on outcomes following TAVR. 30-day and long-term outcomes were measured comparing patients
with Glomerular filtration rate (GFR) ≥60 to those with GFR <60.
Results: Ten studies were analyzed comprising of 8688 patients. Compared to patients with GFR
≥60, those with GFR < 60 had worse 30-day all cause mortality (OR 1.40, 95% CI: 1.13-1.73),
cardiovascular mortality (OR 1.66, 95% CI: 1.04-2.67), strokes (OR 1.39, 95% CI: 1.05-1.85), acute
kidney injury (OR 1.42, 95% CI: 1.21-1.66) and the risk for dialysis (OR 2.13, 95% CI: 1.07-4.22).
There was no difference in device success (p=0.873), major or life threatening bleeds (p = 0.302),
major vascular complications (p=0.525), need for pacemaker implantation (p = 0.393) or
paravalvular leaks (p = 0.630). All-cause mortality at 1 year was also significantly higher in patients
with GFR <60 (OR 1.80, 95% CI: 1.26-2.56).
Conclusion: Pre-existing CKD defined as GFR <60 is a strong predictor of worse short and longterm
outcomes following TAVR. Active measures should be taken to mitigate the postprocedure
risk in these group of patients.