Trends and Outcomes of Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease and Dialysis: Insights From the Nationwide Inpatient Sample (2016–2023)
Abstract
Background Transcatheter aortic valve replacement (TAVR) has become a first-line therapy for severe aortic stenosis across all surgical risk categories. However, patients with advanced chronic kidney disease (CKD) and dialysis dependence remain underrepresented in randomized controlled trials and face disproportionately high procedural risk. Understanding trends and outcomes of TAVR in these populations is critical for guiding clinical decision-making. Methods Retrospective cohort study was performed using Nationwide Inpatient Sample (01/2016–12/2023) data. Adults undergoing TAVR were identified using ICD-10-PCS procedure codes. CKD staging and dialysis dependence were classified using ICD-10 diagnostic codes. Patients were stratified into three groups: no CKD, CKD stage 3–4, and dialysis dependence. Primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), vascular complications, length of stay (LOS), and hospitalization costs. Trends in TAVR volume by CKD status were also evaluated. Multivariable logistic regression was used to adjust for age, sex, comorbidities, hospital teaching status, and procedural volume. Results Of 312,482 TAVR procedures, 22.7% were performed in patients with CKD stage 3–4 and 6.3% in dialysis-dependent patients. In-hospital mortality was significantly higher in dialysis patients (7.8%) compared with CKD stage 3–4 (3.2%) and patients without CKD (1.5%) (p<0.001). AKI rates increased progressively with worsening renal function (4.0%, 9.5%, and 15.2%, respectively; p<0.001). Dialysis patients had longer mean LOS (5.6±2.4 days) compared with CKD stage 3–4 (3.4±1.7 days) and patients without CKD (2.5±1.1 days), along with significantly higher hospitalization costs (p<0.001). Multivariable analysis confirmed dialysis dependence remained independently associated with higher mortality ([aOR] 3.2; 95% CI, 2.8–3.7) and procedural complications. Conclusion Patients with advanced CKD and dialysis dependence undergoing TAVR experience significantly higher mortality, AKI, and LOS compared to patients without kidney disease. These findings emphasize the need for individualized procedural planning, peri-procedural optimization, and risk mitigation strategies to improve outcomes.
Start Time
15-4-2026 9:00 AM
End Time
15-4-2026 12:00 PM
Room Number
Culp Ballroom 316
Poster Number
47
Presentation Type
Poster
Presentation Subtype
Posters - Competitive
Presentation Category
Health
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Vijay Ramu
Trends and Outcomes of Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease and Dialysis: Insights From the Nationwide Inpatient Sample (2016–2023)
Culp Ballroom 316
Background Transcatheter aortic valve replacement (TAVR) has become a first-line therapy for severe aortic stenosis across all surgical risk categories. However, patients with advanced chronic kidney disease (CKD) and dialysis dependence remain underrepresented in randomized controlled trials and face disproportionately high procedural risk. Understanding trends and outcomes of TAVR in these populations is critical for guiding clinical decision-making. Methods Retrospective cohort study was performed using Nationwide Inpatient Sample (01/2016–12/2023) data. Adults undergoing TAVR were identified using ICD-10-PCS procedure codes. CKD staging and dialysis dependence were classified using ICD-10 diagnostic codes. Patients were stratified into three groups: no CKD, CKD stage 3–4, and dialysis dependence. Primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), vascular complications, length of stay (LOS), and hospitalization costs. Trends in TAVR volume by CKD status were also evaluated. Multivariable logistic regression was used to adjust for age, sex, comorbidities, hospital teaching status, and procedural volume. Results Of 312,482 TAVR procedures, 22.7% were performed in patients with CKD stage 3–4 and 6.3% in dialysis-dependent patients. In-hospital mortality was significantly higher in dialysis patients (7.8%) compared with CKD stage 3–4 (3.2%) and patients without CKD (1.5%) (p<0.001). AKI rates increased progressively with worsening renal function (4.0%, 9.5%, and 15.2%, respectively; p<0.001). Dialysis patients had longer mean LOS (5.6±2.4 days) compared with CKD stage 3–4 (3.4±1.7 days) and patients without CKD (2.5±1.1 days), along with significantly higher hospitalization costs (p<0.001). Multivariable analysis confirmed dialysis dependence remained independently associated with higher mortality ([aOR] 3.2; 95% CI, 2.8–3.7) and procedural complications. Conclusion Patients with advanced CKD and dialysis dependence undergoing TAVR experience significantly higher mortality, AKI, and LOS compared to patients without kidney disease. These findings emphasize the need for individualized procedural planning, peri-procedural optimization, and risk mitigation strategies to improve outcomes.
