EHJ: 11%-plus patients suffer acute kidney injury after TAVI

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Acute kidney injury occurred in 11.7 percent of patients following transcatheter aortic valve implantation (TAVI), and was associated with a greater than four-fold increase in the risk of postoperative mortality, according to a Canadian study published online Dec. 27 in the European Heart Journal.

Very few data exist on the occurrence of acute kidney injury associated with TAVI. Rodrigo Bagur, MD, from the Quebec Heart and Lung Institute at Laval University in Quebec City, Quebec, and colleagues sought to determine the incidence, predictive factors and prognostic value of acute kidney injury following TAVI, and to compare the occurrence of acute kidney injury in TAVI versus surgical aortic valve replacement (SAVR) in patients with pre-procedural chronic kidney disease.

The researchers included 213 patients (mean age, 82 years) undergoing TAVI for the treatment of severe aortic stenosis . They defined acute kidney injury as a reduction of more than 25 percent in estimated glomerular filtration rate (eGFR) within 48 hours following the procedure or the need for hemodialysis during index hospitalization.

The 119 patients with pre-procedural chronic kidney disease (eGFR, less than 60 mL/min/1.73 m2) were compared with 104 contemporary patients with chronic kidney disease who underwent isolated SAVR.

They found that the incidence of acute kidney injury following TAVI was 11.7 percent, with 1.4 percent of the patients requiring hemodialysis.

The authors said the predictive factors of acute kidney injury were hypertension, chronic obstructive pulmonary disease and peri-operative blood transfusion.

According to the researchers, 21 patients (9.8 percent) died during index hospitalization, and the logistic EuroSCORE and the occurrence of acute kidney injuries were identified as independent predictors of postoperative mortality. Patients with chronic kidney disease who underwent TAVI were older, had a higher logistic EuroSCORE and lower pre-procedural eGFR values compared with those who underwent SAVR.

The incidence of acute kidney injury was lower in chronic kidney disease patients who underwent TAVI (9.2 percent; need for hemodialysis: 2.5 percent) compared with those who underwent SAVR (25.9 percent; need for hemodialysis: 8.7 percent), wrote Bagur and colleagues.

The researchers concluded hypertension, chronic obstructive pulmonary disease and blood transfusion were predictive factors of acute kidney injury. In those patients with pre-procedural chronic kidney disease, TAVI was associated with a significant reduction of acute kidney injury compared with SAVR.

They also pointed out that the amount of contrast media was not associated with acute kidney injury following TAVI.

Bagur and colleagues wrote that future randomized studies are needed to confirm these results and determine whether their prognostic relevance should lead to the favoring of TAVI in this particular subset of patients.