Top Things to Know: Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease

Published: May 13, 2021

Prepared by Johanna A. Sharp MSN, RN, Science and Medicine Advisor

Patients with chronic kidney disease (CKD) experience a higher prevalence of the entire spectrum of aortic valve disease ranging from calcification to stenosis.
This Scientific Statement evaluates the nuances and prognostic information provided by non-invasive cardiovascular imaging using echocardiography and advanced imaging techniques.
Patients with a combination of CKD and aortic stenosis exhibit distinctive epidemiological and pathophysiological characteristics, presenting diagnostic and management challenges.
Individuals with an eGFR<44 ml/min/1.73m² have a 20% higher adjusted hazard of the incident aortic stenosis and the progression of aortic stenosis is accelerated and unpredictable.
The presence of CKD and aortic stenosis has been associated with worse short-term and long-term outcomes following aortic valve replacement (Table 2).
The presence of CKD is an independent predictor of adverse clinical outcomes following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) when compared to patients without CKD.
This statement provides a critical review of the existing literature pertaining to outcomes of surgical vs transcatheter aortic valve replacement in this high-risk population to support clinical decision-making towards choice of aortic valve replacement and specific protheses (Figure 4).
This Scientific Statement provides a table of clinical factors associated with poor outcomes among patients undergoing surgical vs transcatheter aortic valve replacement. These may be extrapolated to CKD to support clinical decision-making.
The diagnostic evaluation as well as management of aortic stenosis in patients with CKD is complex and requires a multidisciplinary and collaborative effort.
This Scientific Statement provides a table which suggest opportunities for research in the diagnosis and management of aortic stenosis in CKD.

View the summary for Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease

Citation

Shroff GR, Bangalore S, Bhave NM, Chang TI, Garcia S, Mathew RO, Rangaswami J, Ternacle J, Thourani VH, Pibarot P; on behalf of the American Heart Association Council on the Kidney in Cardiovascular Disease and Stroke Council. Evaluation and management of aortic stenosis in chronic kidney disease: a scientific statement from the American Heart Association [published online ahead of print May 13, 2021]. Circulation. doi: 10.1161/CIR.0000000000000979