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.

BACKGROUND: 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).

METHODS: 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).

RESULTS: 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.

CONCLUSIONS: 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.