Article Text

Download PDFPDF

Original research article
Bedside risk score for prediction of acute kidney injury after transcatheter aortic valve replacement
  1. Nevena Zivkovic1,
  2. Gabby Elbaz-Greener1,
  3. Feng Qiu2,
  4. Yaron Arbel3,
  5. Asim N Cheema4,
  6. Danny Dvir5,
  7. Paul Fefer6,
  8. Ariel Finkelstein3,
  9. Stephen E Fremes1,
  10. Sam Radhakrishnan1,
  11. Josep Rodés-Cabau7,
  12. Mony Shuvy8 and
  13. Harindra C Wijeysundera1,2,9
  1. 1 Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  2. 2 Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
  3. 3 Department of Cardiology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  4. 4 Division of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
  5. 5 Division of Cardiology, St Paul’s Hospital, Vancouver, British Columbia, Canada
  6. 6 Heart Institute, Sheba Medical Center, Tel HaShomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
  7. 7 Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
  8. 8 Heart Institute, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
  9. 9 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Harindra C Wijeysundera; Harindra.wijeysundera{at}


Background Acute kidney injury (AKI) is a common post-transcatheter aortic valve replacement (TAVR) complication associated with a poor prognosis. We sought to create a risk calculator using information that would be available during the work-up period.

Methods Data were obtained from a multicentre TAVR registry (n=1993) with cases from 1 January 2012 to 31 December 2015. We used logistic regression to create a risk calculator to predict AKI as defined by the Valve Academic Research Consortium Guidelines. We internally validated our risk calculator using bootstrapping, and evaluated model discrimination and calibration.

Results A simple risk score was derived with six variables, including New York Heart Association functional classification class 4, non-femoral access site, valve-in-valve procedure, haemoglobin, creatinine clearance and weight in kilograms. The score was able to predict the absolute risk of AKI from 1% to 72%. The model showed good discrimination with c-statistic 0.713, with good agreement between predicted and observed AKI rates across quintiles of risk.

Conclusions This is the first risk calculator to assess post-TAVR risk of AKI. We found that information known pre-procedurally can be used to predict AKI. This may allow for more informed decision-making as well as identifying high-risk patients.

  • tavr
  • aortic stenosis
  • aortic regurgitation
  • acute kidney injury

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • 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 consent Not required.

  • Ethics approval Sunnybrook Hospital, St Michael’s Hospital, Quebec Heart and Lung Institute, Tel Aviv Medical Centre, Hadassah Hebrew University Medical Centre and Sheba Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.