Impact of chronic kidney disease on mortality in adults undergoing balloon aortic valvuloplasty

Background: Balloon aortic valvuloplasty (BAV) is often utilized as a bridge prior to surgical or transcatheter aortic valve replacement. Chronic kidney disease (CKD) is commonly present in patients with aortic stenosis, however, its association with outcomes following BAV has not been well studied. Accordingly, we sought to assess the impact of CKD on mortality in adults undergoing BAV. Methods: The Nationwide Inpatient Sample was screened for hospitalizations involving adults undergoing BAV from 2006 to 2012. Demographic data and clinical history were recorded. Patients were divided into those with and without CKD as a documented comorbidity and were compared for adjusted in-hospital mortality risk. Results: Among a national cohort of 10,845 adults undergoing BAV, 3842 (35.4%) adults had CKD while 7003 (64.6%) did not. Patients with CKD were older, more often male, and had higher rates of coronary disease, heart failure, diabetes mellitus, hypertension, peripheral artery disease, obesity, obstructive sleep apnea, and atrial fibrillation. Adults with CKD undergoing BAV had significantly higher in-hospital mortality rates (10.2% vs 6.3%, p = 0.0005). In multivariable analysis, CKD was independently associated with a nearly 2-fold higher odds of in-hospital mortality (odds ratio 1.98, 95% confidence interval 1.45–2.70, p < 0.0001). Other predictors of mortality included presence of atrial fibrillation and absence of prior myocardial infarction, hypertension, peripheral arterial disease, and smoking. Conclusions: CKD was independently associated with a nearly 2-fold higher odds of in-hospital mortality in adults undergoing BAV. Further studies are warranted to determine whether preventive interventions can improve outcomes in this high-risk population.