Elsevier

American Heart Journal

Volume 163, Issue 6, June 2012, Pages 1031-1036
American Heart Journal

Clinical Investigation
Valvular and Congenital Heart Disease
Incidence and predictors of acute kidney injury after transcatheter aortic valve replacement

https://doi.org/10.1016/j.ahj.2012.01.009Get rights and content

Background

Patients undergoing transcatheter aortic valve replacement (TAVR) are at increased risk for acute kidney injury (AKI). The Valve Academic Research Consortium (VARC) recently published criteria for AKI after TAVR. We aimed to identify predictors, assess the prognostic impact of AKI after TAVR, and compare various criteria for AKI.

Methods

Patients with aortic stenosis undergoing TAVR were retrospectively analyzed for periprocedural AKI (<72 hours) according to the VARC definition (increase in serum creatinine ≥0.3 mg/dL or ≥1.5× baseline) or according to the modified Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria (decrease of >25% in estimated glomerular filtration rate at 48 hours).

Results

Acute kidney injury, according to the VARC definition, occurred in 24 (14.6%) of 165 patients after TAVR. Acute kidney injury, according to RIFLE criteria, occurred in 19 patients (11.5%). Men (63% vs 38%, P = .03) and patients receiving blood transfusion (63% vs 39%, P = .04) were more likely to develop AKI. In multivariable analysis, only blood transfusion emerged as a predictor for AKI (odds ratio 3.74, 95% CI 1.36-10.3). Patients who developed AKI had higher in-hospital (21% vs 4%, P = .007) and 30-day mortality (29% vs 7%, P = .004) as compared with patients without AKI.

Conclusion

Acute kidney injury is a frequent complication of TAVR. Even a small increase (0.3 mg/dL) in baseline creatinine post-TAVR is associated with worse outcome. The poor prognosis of these patients should encourage improvement in patient selection and careful management for prevention of this complication.

Section snippets

Methods

This prospective study was approved by the institutional review board of the MedStar Health Research Institute. Consecutive patients with symptomatic severe aortic stenosis who underwent TAVR as part of the PARTNER trials from May 2007 to May 2011 were analyzed for periprocedural AKI.

Prespecified clinical and laboratory data were prospectively collected for all patients on admission, immediately post-TAVR, and during long-term follow-up. Collected data included medical history, medications on

Results

Throughout the study period, a total of 165 patients with severe, symptomatic aortic stenosis underwent TAVR. The average age was 85 ± 6 years, and 42% of the patients were male. The average Society of Thoracic Surgeons risk score was 12% ± 4% with multiple comorbidities; 96% had systemic hypertension, 32% had diabetes, 56% had history of coronary artery disease, 27% had peripheral vascular disease, and 78% had chronic renal insufficiency. The baseline eGFR of this patient cohort was 49 ± 20 mL

Discussion

The main findings of the present study indicate that AKI after TAVR is a frequent complication, which occurs in >10% of patients. These patients have significantly worse outcome. The prohibitive mortality rates of patients who developed AKI were also identified by previous reports that also demonstrated that the 30-day (6.9%-23%)13, 18 and 1-year (54.8%-60%)12, 19 mortality is higher for these patients. It is, thus, imperative to identify patients at risk and to minimize their risks for AKI.

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