Incidence and Predictors of Acute Kidney Injury After TAVR
Incidence and Predictors of Acute Kidney Injury After TAVR
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.
Transcatheter aortic valve replacement (TAVR) offers treatment for high-risk patients with severe aortic stenosis who would otherwise be treated medically. The Placement of Aortic Transcatheter Valves (PARTNER) trials showed improved outcome for patients with TAVR as compared with medical therapy and equivalent efficacy and safety as compared with surgical AVR. Currently, TAVR is performed in high-risk patients with multiple comorbidities and advanced age. These patients frequently have abnormal baseline renal function and are, therefore, at increased risk for acute kidney injury (AKI) after TAVR because of the hemodynamic changes during the procedure and the use of contrast agents.
Surgical AVR is complicated by AKI in up to 25% of patients; this complication was shown to be associated with worse outcome. Similarly, experience from studies in percutaneous coronary interventions indicates that even a small postprocedural increase in serum creatinine is associated with poor outcome. However, data for AKI after TAVR are scarce and inconsistent mostly because of the use of various definitions for AKI. AKI rates range from 1.1% in the PARTNER trial (AKI was defined as creatinine >3 mg/dL) to 28%.
Recently, a consensus report from the Valve Academic Research Consortium (VARC) suggested new criteria for postprocedural AKI based on the modified Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification. Thus, the aim of the present study was to assess the incidence, predictors, and clinical outcome of AKI after TAVR according to the VARC criteria and to compare these outcomes with other previously used definitions.
Abstract and Introduction
Abstract
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.
Introduction
Transcatheter aortic valve replacement (TAVR) offers treatment for high-risk patients with severe aortic stenosis who would otherwise be treated medically. The Placement of Aortic Transcatheter Valves (PARTNER) trials showed improved outcome for patients with TAVR as compared with medical therapy and equivalent efficacy and safety as compared with surgical AVR. Currently, TAVR is performed in high-risk patients with multiple comorbidities and advanced age. These patients frequently have abnormal baseline renal function and are, therefore, at increased risk for acute kidney injury (AKI) after TAVR because of the hemodynamic changes during the procedure and the use of contrast agents.
Surgical AVR is complicated by AKI in up to 25% of patients; this complication was shown to be associated with worse outcome. Similarly, experience from studies in percutaneous coronary interventions indicates that even a small postprocedural increase in serum creatinine is associated with poor outcome. However, data for AKI after TAVR are scarce and inconsistent mostly because of the use of various definitions for AKI. AKI rates range from 1.1% in the PARTNER trial (AKI was defined as creatinine >3 mg/dL) to 28%.
Recently, a consensus report from the Valve Academic Research Consortium (VARC) suggested new criteria for postprocedural AKI based on the modified Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification. Thus, the aim of the present study was to assess the incidence, predictors, and clinical outcome of AKI after TAVR according to the VARC criteria and to compare these outcomes with other previously used definitions.
