Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement

Abstract

Background Acute kidney injury after cardiac surgery significantly associates with morbidity and mortality. Despite not requiring cardiopulmonary bypass, transcatheter aortic valve replacement patients have an incidence of post-procedural acute kidney injury similar to patients who undergo open surgical aortic valve replacement. Packed red blood cell transfusion has been associated with morbidity and mortality after cardiac surgery. We hypothesized that packed red blood cell transfusion independently associates with acute kidney injury after transcatheter aortic valve replacement, after accounting for other risk factors. Methods This is a single-center retrospective cohort study of 116 patients undergoing transcatheter aortic valve replacement. Post-transcatheter aortic valve replacement acute kidney injury was defined by Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Univariate comparisons between patients with and without post-transcatheter aortic valve replacement acute kidney injury were made for clinical characteristics. Multivariable logistic regression was used to assess independent association of packed red blood cell transfusion with post-transcatheter aortic valve replacement acute kidney injury (adjusting for pre-procedural renal function and other important clinical parameters). Results Acute kidney injury occurred in 20 (17.2%) subjects. Total number of packed red blood cells transfused independently associated with post-procedure acute kidney injury (OR = 1.67 per unit, 95% CI 1.13–2.47, P = 0.01) after adjusting for pre-procedure estimated glomerular filtration rate (OR = 0.97 per ml/min/1.73m 2 , 95% CI 0.94–1.00, P = 0.05), nadir hemoglobin (OR = 0.88 per g/dL increase, CI 0.61–1.27, P = 0.50), and post-procedure maximum number of concurrent inotropes and vasopressors (OR = 2.09 per inotrope or vasopressor, 95% CI 1.19–3.67, P = 0.01). Conclusion Packed red blood cell transfusion, along with post-procedure use of inotropes and vasopressors, independently associate with acute kidney injury after transcatheter aortic valve replacement. Further studies are needed to elucidate the pathobiology underlying these associations.

Evaluating the Association between Contrast Medium Dosage and Acute Kidney Injury in Transcatheter Aortic Valve Replacement Using Different Predictive Models

“…Advanced peripheral vascular disease is also thought to accentuate the adverse effects of RBU [2]. RBU transfusion is reported to be an independent predictor of AKI in TAVR and in a meta-analysis shown to be associated with AKI [8,33,36,37]. Accordingly, the number of RBU transfusions was significantly higher both amongst our patients and other reported cohorts [3,13,38].…”

“…It has also been postulated that hypotension triggered by rapid pacing may cause renal hypoperfusion and therefore renal injury and AKI [31]. Although studies have reported no difference or association between utilization of rapid pacing and AKI incidence [32,33], there are conflicting reports with respect to the effects of the number of pacing runs/episodes on AKI development [15,34], and a recent study by Fefer et al has shown that prolonged rapid pacing time increases the risk of AKI [34].…”

Dose approach matter? A meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement

“…Moreover, the high incidence of AKI in TA-TAVR patients can also be ascribed to the transfusion for there were more major bleeding events in TA group. Transfusion has been proved to be an independent predictor of AKI as it is associated with the coadministration of some other causative molecular and cellular substances causing kidney injury, such as interleukin-8 which typically accumulates in stored packed red cells [44]. So it is reasonable to emphasize the importance of close monitoring of perioperative renal function, as well as a strict surgical discipline in the execution of TA-TAVR by-among others-strict control of hemostasis, especially the puncture site on heart.…”

Dose approach matter?A Meta-analysis of outcomes following transfemoral versus transapical transcatheter aortic valve replacement

“…Moreover, the high incidence of AKI in TA-TAVR patients can also be ascribed to the transfusion for there were more major bleeding events in TA group. Transfusion has been proved to be an independent predictor of AKI as it is associated with the coadministration of some other causative molecular and cellular substances causing kidney injury, such as interleukin-8 which typically accumulates in stored packed red cells [41]. So it is reasonable to emphasize the importance of close monitoring of perioperative renal function, as well as a strict surgical discipline in the execution of TA-TAVR by -among others -strict control of hemostasis, especially the puncture site on heart.…”