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Kidney dysfunction and short term all-cause mortality after transcatheter aortic valve implantation

      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)
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