Classification of Chronic Kidney Stages Could Help With Risk Stratification Before TAVI Separate Study Finds Increased CM Volume May Influence Acute Kidney Injury Risk

Classification of chronic kidney disease (CKD) stages could be a useful tool for potential risk stratification before transcatheter aortic valve implantation (TAVI), according to a new study published in the Journal of the American College of Cardiology (JACC).

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The study classified 642 consecutive TAVI patients into four groups: CKD 1+2, CKD 3a, CKD 3b and CKD 4 based on the estimated glomerular filtration rate: ≥60, 45–59, 30–44, and 15-29 ml/min/1.73m2, respectively. Overall results showed both the 30-day and cumulative 1-year mortality rates increased significantly across the four groups. However, the study investigators noted, that after adjustment for considerable influential confounders in COX-regression multivariate model, patients in the CKD 4 group had an increased risk of 30-day mortality (HR: 3.04, 95%CI: 1.43-6.49, p=0.004). Patients in the CKD 3b and 4 groups also had increased cumulative 1-year mortality (HR: 1.71, 2.91; 95%CI: 1.09-2.68, 1.73-4.90; p=0.020, <0.001, respectively) when compared to the CKD 1+2 groups as reference.

In particular, the study investigators highlight that CKD stage 4 patients had a very high 30-day (26.2%) and 1-year (47.8%) mortality rate, continuing to make TAVI challenging for this group.

"In the next phase of evolution of TAVI, we need to obtain more detailed information on the side effects of TAVI to fully understand what predicts outcome in specific groups of patients such as those with CKD," noted Olaf Wendler MD, PhD, professor of cardiac surgery at King's College Hospital/King's Health Partners in Denmark, in a related editorial comment. "This will improve our case selection and enable us to tailor interventional and surgical treatment to individual patients, ultimately improving the outcome of this exciting new treatment option."

On a related note, a separate study published in JACC: Cardiovascular Interventions,  indicates that the volume of contrast media (CM) may influence the occurrence of acute kidney injury (AKI) following TAVI.

The study, which looked at 415 TAVI patients, found that AKI occurred in 63 patients (15.2 percent). Cumulative 1-year mortality showed significant differences between the AKI and non-AKI groups (47.9 percent vs. 15.7 percent, p _ 0.001), while mean CM _ SCr/BW ratio was higher in the AKI group than in the non-AKI group (4.1 _ 2.9 vs. 2.9 _ 1.6, p _ 0.001). Data also showed Low LVEF (_40 percent) and RBC transfusion to be significant predictive factors of AKI.

Based on the results, the investigators suggest that "therapeutic efforts not to exceed the threshold value may reduce the risk of AKI."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Contrast Media, Cardiology, Acute Kidney Injury, Glomerular Filtration Rate, Cardiac Surgical Procedures, Renal Insufficiency, Chronic, United States

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