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Aortic stenosis in chronic kidney disease: challenges in diagnosis and treatment
  1. Jessica I Gupta1,2,
  2. Sarah K Gualano1,2,
  3. Nicole Bhave1,2
  1. 1 Internal Medicine, Division of Cardiology, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA
  2. 2 Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Jessica I Gupta, Internal Medicine, Division of Cardiology, Ann Arbor VA Medical Center, Ann Arbor, MI 48105, USA; jparsh{at}med.umich.edu

Abstract

Chronic kidney disease (CKD) is becoming increasingly common and is associated with development and rapid progression of aortic stenosis (AS). Patients with AS and CKD have higher mortality rates than those with AS of similar severity and normal kidney function. The diagnosis of severe AS in patients with CKD is often challenging due to alterations in haemodynamics and heart structure, and integration of data from multiple imaging modalities may be required. When indicated, the definitive treatment for severe AS is aortic valve replacement. Patients with CKD are candidates for bioprosthetic valve replacement (surgical or transcatheter aortic valve implantation) or mechanical valve replacement. However, for patients with CKD, lifetime management is complex, as patients with CKD have a higher competing risk of bioprosthetic structural valve deterioration, bleeding in the setting of systemic anticoagulation and mortality related to CKD itself. The involvement of a heart-kidney multidisciplinary team in the care of patients with CKD and severe AS is ideal to navigate the complexities of diagnosis and management decisions.

  • aortic valve stenosis
  • cardiac imaging techniques
  • echocardiography
  • heart valve prosthesis
  • computed tomography angiography

http://dx.doi.org/10.1136/heartjnl-2021-319604

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    Footnotes

    • Twitter @NicoleBhaveMD

    • Contributors All authors have contributed to and approved of the final review.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.