Aortic Stenosis in End-Stage Renal Disease: Incidence, Prevalence, and Mortality in a National Korean Cohort

Abstract

Background/Objectives: Aortic stenosis (AS) is an increasingly recognized end-stage renal disease (ESRD) complication. This study aimed to identify AS incidence and prevalence in Korean patients with ESRD, assess the effect of AS on all-cause mortality, and determine associated risk factors unique to this population. Methods: This retrospective study used Korean National Health Insurance Service data from 2009 to 2021 and included adult patients with ESRD undergoing maintenance dialysis. AS was identified based on diagnostic codes, and 4:1 propensity score matching was conducted. Temporal trends in AS incidence and prevalence were analyzed in terms of sex and age. Kaplan-Meier survival analysis and Cox proportional hazards models were employed for all-cause mortality assessment. Results: Among 91,466 eligible patients, 708 (0.77%) had AS. AS incidence and prevalence increased from 8.05 to 35.29 and from 8.05 to 77.43 per 10,000, respectively, from 2009 to 2021, and were higher in women than in men. Age-stratified analysis revealed the greatest burden in patients aged >= 80. AS in the matched cohort (n = 2875) was associated with <10-year survival (13% vs. 24%, p < 0.001), with differences evident from age 60 onward. Multivariable analysis revealed AS as an independent mortality predictor (hazard ratio: 1.23, 95% confidence interval: 1.08-1.40, p = 0.002). Older age, atrial fibrillation, stroke, and a higher Charlson Comorbidity Index were significant mortality predictors among patients with AS. Conclusions: AS burden in dialysis-dependent patients with ESRD is markedly increasing, particularly among women and older adults, and is independently associated with elevated mortality.