The incidence, predictors, and prognosis of acute kidney injury after transcatheter aortic valve implantation

Attard, Stephanie; Buttigieg, Jesmar; Galea, Stephanie; Mintoff, Malcolm; Farrugia, Emanuel; Cassar, Andrew

doi:10.5414/cn109544

Cited by 12 publications

(8 citation statements)

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“…Previous chronic kidney disease has uncertain impact on post-procedure AKI [23, 24]. In a previous study from the Brazilian registry, chronic kidney disease was not an independent predictor of AKI after TAVR [11].…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…AKI occurred in 20.7% to 41.7% of patients after TAVR and was associated with increased mortality [Attard 2018;Kumar 2019;Nuis 2012;Saia 2013]. Underlying risk factors of AKI involved chronic kidney disease (CKD), higher median EuroSCORE-II, peripheral artery disease, prior coronary artery bypass grafting, number of blood transfusions ≤24 hours [Aalaei-Andabili 2016; Attard 2018; Nuis 2012].…”

Section: Discussionmentioning

confidence: 99%

General Anesthesia Increased the Risk of Atrial Fibrillation and Acute Kidney Injury in Transcatheter Aortic Valve Replacement

Liang

Wang

et al. 2021

HSF

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Purpose: To examine key impacts of anesthesia on new-onset atrial fibrillation (AF) and acute kidney injury (AKI) in transcatheter aortic valve replacement (TAVR). Methods: All consecutive patients who underwent transfemoral, transapical, and transaortic TAVR in Fuwai Hospital from 2012 to 2018 were retrospectively analyzed and dichotomized into 2 groups: TAVR under conscious sedation (CS) and under general anesthesia (GA). The primary endpoint was a composite of all-cause mortality, stroke, AF, permanent pacemaker implantation, myocardial infarction, heart failure, high-grade atrioventricular block, and AKI at 1 year. Binary logistic regression and adjusted multilevel logistic regression were performed to analyze the predictors of AF and AKI. Results: A total of 107 patients were under CS and 66 patients under GA. No significant difference was observed in the composite endpoint (51.5% vs. 41.2%, GA vs. CS, P = .182) and ≥ mild paravalvular leakage (36.4% vs. 31.4%, GA vs. CS, P = .589) at 1 year. However, the GA group had a significantly higher rate of intensive care unit (ICU) admission (84.8% vs. 6.5%, P < .001), AKI (28.8% vs. 14.0%, P = .018), new-onset AF (15.2% vs. 5.5% at 1 year, P = .036). Multivariable analysis revealed GA to be the significant predictor of new-onset AF (odds ratio 3.237, 95% confidence interval 1.059 to 9.894, P = .039) and AKI (odds ratio 2.517, 95% confidence interval 1.013 to 6.250, P = .047). Conclusion: GA was associated with higher rates of ICU admission, postoperative AKI, and new-onset AF. The results may provide new evidence that CS challenges universal GA.

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“…While patients with CKD are at increased risk for short-and long-term mortality among high-surgical-risk patients undergoing TAVI, there is no association between CKD and mortality in low-to intermediate-risk patients [4]. Publications analyzing the risk of acute kidney injury (AKI) after TAVI are also inconclusive [5][6][7][8][9]. Since publications focus on AKI after TAVI, little is known about the impact of aortic valve stenosis, the total workflow of pre-procedural TAVI diagnostics and the procedure itself on short-and long-term renal function.…”

Section: Introductionmentioning

confidence: 99%

The impact of transcatheter aortic valve implantation planning and procedure on acute and chronic renal failure

et al. 2023

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Background: Severe aortic valve stenosis inhibits renal perfusion, thereby potentially worsening renal function, in particular in elderly patients most often assigned to transcatheter aortic valve implantation (TAVI). Pre-TAVI diagnostics and the procedure itself may adversely impact renal function, however renal perfusion and function may also improve postprocedure. This study aimed to clarify the impact of TAVI planning and procedure on kidney function Methods: In this retrospective study, kidney function of patients who underwent transfemoral TAVI at a tertiary university hospital between 2016 and 2019 was analyzed. The present study investigated kidney function at baseline, after computed tomography (CT) was performed for evaluation of TAVI, after TAVI, at discharge and at follow-up.Results: Among 366 patients, the prevalence of acute kidney injury (AKI) was 14.5% after TAVI. Independent predictors of AKI were arterial hypertension, baseline creatinine, AKI post CT and coronary intervention during pre-procedural diagnostics. At discharge and follow-up, 2.1% and 3.4%, respectively had sustained relevant impairment of kidney function (defined as creatinine/baseline creatinine > 1.5 or renal replacement therapy). Patients with known chronic kidney disease showed no higher rates of short-and long-term impairment, but higher rates of improvement of renal function after TAVI. Conclusions:In most cases TAVI does not worsen renal function. A sustained impairment after TAVI was found in only a few cases. This was independent of reduced baseline kidney function. Transfemoral TAVI can thus be planned and performed even in patients with higher stages of chronic kidney disease.

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The incidence, predictors, and prognosis of acute kidney injury after transcatheter aortic valve implantation

Cited by 12 publications

References 0 publications

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

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

General Anesthesia Increased the Risk of Atrial Fibrillation and Acute Kidney Injury in Transcatheter Aortic Valve Replacement

The impact of transcatheter aortic valve implantation planning and procedure on acute and chronic renal failure

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