Patients With AKI After SAVR May Experience Worse Outcomes

Patients who experience acute kidney injury (AKI) after surgical aortic valve replacement (SAVR) may experience worse outcomes according to a research letter presented Nov. 7 at the American Society of Nephrology's Annual Meeting, and simultaneously published in the Journal of the American College of Cardiology.

Researchers led by Linda C. Rydén, MD, PhD, from Karolinska University Hospital in Sweden, identified all patients who underwent a primary isolated SAVR between 1999 and 2013 in the SWEDEHEART registry. After exclusions, they examined 9,047 patients, and 1,523 patients (17 percent) developed AKI. Patients with AKI were older and had more comorbidities than those without AKI.

During a mean follow-up of 5.6 ± 3.7 years, 2,109 patients (23 percent) died and 29 (0.3 percent) developed end-stage renal disease. Results showed that long-term mortality was almost double in stage 1 AKI and increased more than three-fold in stages 2 to 3 AKI. Patients in stage 1 were at a 27 percent increased adjusted relative risk of death and this risk was more than double in patients in stages 2 to 3. Further, the incidence and relative risk of end-stage renal disease increased with advancing AKI.

"These findings strengthen the idea that there may well be a causal relationship between AKI and adverse outcomes and that AKI may not merely be a marker of more advanced atherosclerotic disease," the authors write. "From a clinical perspective, we believe that our findings underscore the need for close monitoring of patients with AKI."

Clinical Topics: Cardiac Surgery, Aortic Surgery

Keywords: Acute Kidney Injury, Aortic Valve, Heart Valve Prosthesis, Kidney Failure, Chronic, Nephrology

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