https://doi.org/10.1007/s00392-025-02737-x
1Robert-Bosch-Krankenhaus Kardiologie und Angiologie Stuttgart, Deutschland; 2Robert-Bosch-Krankenhaus Stuttgart, Deutschland; 3Robert-Bosch-Krankenhaus GmbH Allgemeine Innere Medizin und Nephrologie Stuttgart, Deutschland
Introduction
Severe tricuspid regurgitation (TR) can cause significant organ dysfunction due to venous congestion, particularly affecting renal function. However, data on the impact of TR on kidney function and outcomes after interventional treatment remain scarce. This study aims to investigate the renal function and number of hospitalizations of patients with severe TR before and after T-TEER (transcatheter edge-to-edge repair) procedure.
Methods
This retrospective, single-center study included patients with severe TR who underwent T-TEER at the Robert Bosch Hospital Stuttgart between March 2021 and February 2023. The intervention was successful in all patients, resulting in a reduction of TR severity by at least one grade. The median observation period was 58 days (IQR 30-120, max. 375 days) before and 125 days (IQR 8-506, max. 1280 days) after T-TEER. Follow up included all routine records in our electronic health records (HER) mostly of hospitalized patients.
Results
Among the 181 patients analysed (median age: 82 years [IQR: 78–84], 60% female), the baseline renal function showed a median estimated glomerular filtration rate (eGFR, CKD-EPI) of 53 mL/min/1.73m² [41-65]. Median eGFR increased (+6.8 ml/min/1.73 m², p < 0.0001), while creatinine, potassium, and urea levels significantly decreased (all p < 0.0001). Additionally, markers of congestive hepatopathy, such as GGT, significantly reduced. The median hospital admission rate per patient per month declined from 0.72 (421 total admissions) before to 0.06 (210 total) after the intervention (Figure 5).
Conclusions
Our data indicate substantial benefit from T-TEER in patients with severe tricuspid regurgitation and chronic kidney disease. Post-intervention, renal function markers as well as biomarkers for volume overload improved while hospitalisation rates decreased substantially. This reflects potential clinical stabilization and renal functional recovery in many patients.
Table 1: Baseline Characteristics
|
Variable |
Value |
|
Age* (years) |
82 [78 – 84] |
|
BMI* (kg/m²) |
26.6 [23.8 – 28.0] |
|
Length of stay for TriClip procedure (days) |
7 [5 – 14] |
|
eGFR*† (ml/min/1.73m²) |
52.7 [40.9 – 64.8] |
|
Male |
108 (59.7%) |
|
KDIGO CKD Stage*† |
|
|
eGFR > 60 (ml/min/1.73m²) |
61 (35.5%) |
|
G3a |
52 (30.2%) |
|
G3b |
45 (26.2%) |
|
G4 |
14 (8.1%) |
|
Dialysis |
|
|
Patients prior to T-TEER (n) |
9 |
|
Patients starting dialysis after T-TEER (n) |
11 |
|
Time to dialysis after T-TEER (days) |
98 [15.5 – 696] |
|
Hospitalizations |
|
|
before T-TEER (n) |
421 |
|
after T-TEER (n) |
210 |
|
Deaths |
|
|
After T-TEER (n) |
20 |
|
Time to death after T-TEER (days) |
342 [134.3 – 678.8] |
* at admission for TriClip †without dialysis prior to T-TEER
Figure 1: Laboratory markers of fluid retention and congestion before and after T-TEER
a)
b)
c)
d)
Figure 2: eGFR slope before and after T-TEER
Figure 3: Hospitalisation rates before and after T-TEER