Prospective evaluation of aortic stenosis in end-stage kidney disease: a more fulminant process?

Background. We have previously demonstrated an increased rate of progression of aortic stenosis (AS) in patients with end-stage kidney disease (CKD 5D) compared to controls. We sought to follow prospectively a CKD 5D cohort with AS and determine major event-free survival. Follow-up was terminated once all CKD 5D subjects had undergone aortic valve replacement (AVR) or died. Our aim was to determine whether the increased rate of progression resulted in shorter major event-free (AVR or death) survival as compared to controls. Methods. We re-matched our original CKD 5D cohort (n = 27) to a control cohort (n = 27) based on aortic valve area (AVA) at completion of the prior study. This was done as CKD 5D and AVA were the only statistically significant variables with respect to rate of progression. Results. All the CKD 5D patients (100%) underwent surgery or died during the follow-up period. In contrast, 17 (63%) of the controls underwent surgery or died. Of the remaining 10 controls, nine remain alive and free of AVR and one was lost to follow-up. Conclusion. The controls displayed greater major event-free survival (P = 0.001), suggesting a need to consider patients with CKD 5D and AS for early AVR once echocardiographic evidence of moderate to severe AS is present, regardless of symptoms.