Chronic kidney disease, even in moderate or severe stages before dialysis, is associated with an increased risk of aortic stenosis according to this work recently published in J Am Coll Cardiol.

Both share several risk factors, something that complicates the identification of the association between these diseases due to multiple confounding variables.

The study included 1,121,875 Stockholm citizens without a history of aortic stenosis from the SCREAM (Stockholm CREAtinine Measurements) project. The glomerular filtration rate (mL/min/1.73 m2) was calculated from serum creatinine. The association between glomerular filtration and aortic stenosis incidence was estimated with multivariable Cox proportional hazards models.

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The sensitivity analysis included possible reverse causation bias (the hypothesis that aortic stenosis causes renal insufficiency) by excluding diagnosis in the first 6 months or 2 years after enrollment and excluding patients with comorbid heart failure.

Mean patient age was 50 years and the glomerular filtration rate was 96 mL/min/1.73 m2.

During a 5.1-year follow-up, 5858 (0.5%) patients developed aortic stenosis (incidence rate: 1.13/1000 years-patient).

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Compared with patients whose filtration rate remained above 90 mL/min/1.73 m² (incidence rate: 0.34/1000 years-patient), as the glomerular filtration rate went down, the incidence of aortic stenosis went up. For patients with a filtration rate between 60 and 90 mL/min/1.73 m², the hazard ratio (HR) was 114 and the 95% confidence interval (CI) was 1.05 to 1.25; for patients with a filtration rate between 45 and 59 mL/min/1.73 m², the HR was 1.17 and the 95% CI was 1.05 to 1.30; for those between 30 and 44, the HR was 1.22 and the 95% CI was 1.07 to 1.39; and finally, for patients whose glomerular filtration was below 30, the HR was 1.56 and the 95% CI was 1.29 to 1.87.

Conclusion

Renal impairment, from moderate stages upwards, is associated with an increased risk of aortic stenosis.

Original title: Kidney Dysfunction and the Risk of Developing Aortic Stenosis.

Reference: Georgios Vavilis et al. J Am Coll Cardiol 2019;73:305-14.

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