The evaluation and management of aortic stenosis (AS) in patients with chronic kidney disease (ERC) is complex and clinically difficult and requires a multidisciplinary approach based on heart and kidney equipment, according to the American Heart Association (AHA) in a new scientific statement.
“There are several facets in which this population differs markedly from the population that does not belong to ERC disease and therefore deserves focused experience and attention to the details described,” says the drafting group, led by Gautam Shroff, MBBS , Hennepin County Medical Center, Minneapolis, Minnesota.
The 28-page statement was published online today in the magazine Circulation.
Unique high risk population
The need for a scientific statement on the assessment and treatment of AS in CKD was identified by the AHA Council on Kidney in Cardiovascular Diseases. An editorial team with experience in this subject was commissioned to review the current literature and prepare a consensus summary based on experts.
The drafting group notes that patients with a combination of CKD and AS have distinctive epidemiological and pathophysiological features, presenting diagnostic and management challenges.
AS is more common and progresses more rapidly and unpredictably in patients with CKD, and the presence of CKD is associated with worse outcomes in the short and long term after the aorta. valve replacement, they point out.
Patients with advanced CKD and end-stage renal disease have been excluded from randomized trials, forcing physicians to make complex management decisions based on retrospective and observational evidence.
The statement summarizes the epidemiological and pathophysiological characteristics of SA in the context of CKD; evaluates the nuances and prognostic information provided by noninvasive cardiovascular imaging with echocardiography and advanced imaging techniques; and highlight the special risks in this population, they write.
It also provides a “critical review” of the available literature related to the clinical outcomes of surgery vs. catheter aortic valve replacement (TAVR) in this high-risk population. This information should help doctors make decisions about the choice of aortic valve replacement and specific prosthesis, the drafting group adds.
The statement notes that aortic valve replacement (AVR) is associated with improved survival, but the presence of ERC is also an independent predictor of adverse clinical outcomes in patients after surgical AVR (SAVR) and TAVR. compared with patients without CKD.
The statement provides a strategy for the perioperative treatment of these patients, with special attention to a multidisciplinary approach based on cardiac-kidney collaboration team.
The drafting group also highlights key opportunities for research in the diagnosis and management of AS in the ERC population, which they hope will inspire future studies to improve the clinical knowledge of this unique population, which will lead to improved clinical outcomes.
Disclosures for drafting group members are available with the original article.
Circulation. Published online May 13, 2021. Summary