Highlights
- •Post-procedural AKI is associated with increased short-term mortality in patients treated with TAVI.
- •Patients with severe CKD with AKI showed the highest 30-day mortality risk.
- •Closer monitoring and specific kidney protection therapies are required for AKI prevention after TAVI.
Abstract
Background
Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) has
been associated with worse outcomes. However, the impact on outcome of AKI in TAVI-patients
is not well established.
Methods
Inoperable patients with severe aortic stenosis (AS) undergoing TAVI in 2010-2018
were enrolled in this study. AKI and chronic kidney disease (CKD) were defined according
to KDIGO guidelines. Patients were divided in two groups according to post-procedural
AKI development. The primary endpoint was 30-day all-cause mortality across the two
groups.
Results
A total of 373 patients (mean age 82.3 ± 6) were analyzed. Compared to non-AKI patients,
those who developed AKI, were treated more frequently with trans-apical TAVI (66%
vs 35%, p<0.01), with greater amount of contrast medium (200.6 vs 170.4 ml, p=0.02)
and in presence of clinically significant peripheral artery disease (PAD, 33% vs 21%,
p=0.04). Trans-apical access (OR 3.24, 95% CI 1.76-5.60, p<0.01) was associated with
a 3-fold risk of AKI. After adjustment for age, Society of Thoracic Surgery risk score
(STS), PAD, access type, EF and contrast medium amount, patients with AKI presented
an increased risk of 30-day all-cause mortality (HR=1.25, 95%CI 1.09-1.69, p=0.008).
Patients with CKD IV and V, who developed AKI, presented a 9-fold 30-day mortality
risk (HR=9.71, 95% CI 2.40-39.2, p=0.001).
Conclusion
In our analysis, AKI was a strong predictor of 30-day all-cause mortality. Particularly,
patients with severe CKD with AKI showed the highest 30-day mortality risk. Thus,
this group of patients might benefit from closer monitoring and specific kidney protection
therapies.
Keywords
Abbreviations:
AKI (acute kidney injury), TAVI (transcatheter aortic valve implantation), CV (cardiovascular), AS (aortic stenosis), CKD (chronic kidney disease), KDIGO (kidney disease improving global outcome), PAD (peripheral artery disease), STS (society of thoracic surgery), EF (ejection fraction), VARC (valvular academic research consortium), CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration), Scr (serum creatinine), EC (ethic committee), NYHA (new york heart association), AVAi (aortic valve area index), eGFR (estimated glomerular filtration rate), SAVR (surgical aortic valve replacement)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 30, 2020
Accepted:
May 16,
2020
Received in revised form:
April 29,
2020
Received:
December 14,
2019
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
