Impact of Acute Kidney Injury on Short- and Long-term Outcomes After Transcatheter Aortic Valve Implantation

Filho, Antonio Carlos Bacelar Nunes; Katz, Marcelo; Campos, Carlos M.; Carvalho, Lucila; Siqueira, Dimytri; Tumelero, Rogério Tadeu; Portella, Antenor L.F.; Esteves, Vinícius; Perin, Marco Antônio; Sarmento‐Leite, Rogério; Neto, Pedro Alves Lemos; Tarasoutchi, Flávio; Bezerra, Hiram G.; Brito, Fábio Sândoli de

doi:10.1016/j.rec.2017.11.024

Cited by 15 publications

(18 citation statements)

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“…[9] Patients suffering from AKI after TAVR tend to have higher 30-day and late mortality. [10,11] Results of former studies present a higher incidence of AKI after TAVR among frail patients, although most of them do not reach statistical significance. [6,12,13] Moreover, frailty assessment is proved to be a strong predictive indicator for functional outcomes and quality of life in patients undergoing TAVR.…”

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The impact of preoperative frailty status on outcomes after transcatheter aortic valve replacement

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Section: Introductionmentioning

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The impact of preoperative frailty status on outcomes after transcatheter aortic valve replacement

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“…It has been shown that significant AKI (stage 2 or 3) was associated with an increase in all-cause mortality, mainly in more advanced stages, including those who required dialysis [11, 20-22]. Thus, although the models had poor accuracy in detecting lower risk of AKI, stage 2/3 is the most clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, although the models had poor accuracy in detecting lower risk of AKI, stage 2/3 is the most clinically relevant. Furthermore, post-procedure AKI is also related to higher incidence of cardiovascular mortality, cerebrovascular accidents, and myocardial infarction [11, 22]. Unexpectedly, only the volume-to-creatinine clearance ratio was an independent predictor of 30-day mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Both baseline and post-procedural renal failure are risk factors for increased mortality and complications after TAVR [8, 9]. Specifically, TAVR-related acute kidney injury (AKI) is frequently observed and is related to higher all-cause mortality, cardiovascular mortality, myocardial infarction, and life-threatening bleeding [10, 11]. However, current available risk scores for AKI have not been validated for patients undergoing TAVR.…”

Section: Introductionmentioning

confidence: 99%

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Performance of Prediction Models for Contrast-Induced Acute Kidney Injury after Transcutaneous Aortic Valve Replacement

et al. 2021

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Background: Acute kidney injury (AKI) has shown to adversely affect outcomes in patients undergoing transcutaneous aortic valve replacement (TAVR), and its correct risk estimation may interfere in procedural planning and strategies. The aim of the study was to test and compare 6 scores in predicting AKI after TAVR. Methods: We tested 6 scores (the contrast material limit score, volume-to-creatinine clearance ratio, ACEF, CR4EATME3AD3, Mehran model A, and Mehran model B) in a total of 559 consecutive patients included in the Brazilian TAVR registry. Results: All scores had a poor accuracy and calibration to predict the occurrence of AKI grade 1 or 2. All scores improved the accuracy of AKI risk prediction when stratified for AKI grade 2/3 and AKI grade 3 for all scores. The CR4EATME3AD3 was the best predictor of AKI stage 2/3 (AUC: 0.62; OR: 1.12; 95% CI 1.01–1.26; p = 0.04) and AKI stage 3 (AUC: 0.64; OR: 1.16; 95% CI 1.02–1.32; p = 0.02). Mehran models A and B were both good models for AKI stage 3 (AUC: 0.63; OR: 1.10; 95% CI 1.01–1.22; p = 0.05; and AUC: 0.62; OR: 1.10; 95% CI 1.00–1.21; p = 0.05, respectively). Conclusions: None of the current models demonstrated validity in detecting AKI when its lower grades were evaluated. CR4EATME3AD3 was the best score in predicting moderate to severe AKI after TAVR. These findings suggest that contrast-induced AKI may not be the only factor related to kidney injury after TAVR.

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“…Among the patients currently undergoing TAVR, a high prevalence of non-cardiac comorbidities are frequently observed, including chronic kidney disease (CKD) that ranged from 52% to 72% in prior studies [9][10][11]. Moreover, renal function impairment at baseline also denotes worse clinical outcomes following TAVR, including higher mortality rates [10][11][12][13][14], particularly when acute kidney injury (AKI) after TAVR ensues [9,[15][16][17]. Of note, some patients may also experience renal function improvement after TAVR, regardless of the baseline renal condition, and also despite the various procedural factors that could jeopardize renal function such as hypotension during rapid pacing, use of iodinated contrast media, bleeding and athero-emboli.…”

Section: Introductionmentioning

confidence: 99%

Improvement of renal function after transcatheter aortic valve replacement in patients with chronic kidney disease

et al. 2021

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Background Chronic kidney disease is commonly found in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) and has marked impact in their prognosis. It has been shown however that TAVR may improve renal function by alleviating the hemodynamic barrier imposed by AS. Nevertheless, the predictors of and clinical consequences of renal function improvement are not well established. Our aim was to assess the predictors of improvement of renal function after TAVR. Methods The present work is an analysis of the Brazilian Registry of TAVR, a national non-randomized prospective study with 22 Brazilian centers. Patients with baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m2) were stratified according to renal function after TAVR: increase >10% in eGFR were classified as TAVR induced renal function improvement (TIRFI); decrease > 10% in eGFR were classified as acute kidney injury (AKI) and stable renal function (neither criteria). Results A total of 819 consecutive patients with symptomatic severe AS were included. Of these, baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m2) was present in 577 (70%) patients. Considering variance in renal function between baseline and at discharge after TAVR procedure, TIRFI was seen in 197 (34.1%) patients, AKI in 203 (35.2%), and stable renal function in 177 (30.7%). The independent predictors of TIRFI were: absence of coronary artery disease (OR: 0.69; 95% CI 0.48–0.98; P = 0.039) and lower baseline eGFR (OR: 0.98; 95% CI 0.97–1.00; P = 0.039). There was no significant difference in 30-day and 1-year all-cause mortality between patients with stable renal function or TIRFI. Nonetheless, individuals that had AKI after TAVR presented higher mortality compared with TIRFI and stable renal function groups (29.3% vs. 15.4% vs. 9.5%, respectively; p < 0.001). Conclusions TIRFI was frequently found among baseline impaired renal function individuals but was not associated with improved 1-year outcomes.

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Impact of Acute Kidney Injury on Short- and Long-term Outcomes After Transcatheter Aortic Valve Implantation

Cited by 15 publications

References 33 publications

The impact of preoperative frailty status on outcomes after transcatheter aortic valve replacement

The impact of preoperative frailty status on outcomes after transcatheter aortic valve replacement

Performance of Prediction Models for Contrast-Induced Acute Kidney Injury after Transcutaneous Aortic Valve Replacement

Improvement of renal function after transcatheter aortic valve replacement in patients with chronic kidney disease

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