Acute kidney injury (AKI) may be common after TAVR and was identified in more than 10% of patients after the procedure, according to a study published April 20 in the Circulation: Cardiovascular Interventions.

Howard M. Julien, MD, MPH, ML, FACC, et al., used the STS/ACC TVT Registry to examine 107,814 patients who underwent TAVR from Jan. 1, 2016, to June 30, 2018, in the U.S. The researchers identified AKI using the AKI Network criteria from stage 0 through stage 3. They measured patient and clinical factors with logistic regression and compared one-year mortality among all patients using data from the Centers for Medicare and Medicaid Services (CMS) administrative files.

Results showed that 10.7% of patients developed postprocedural AKI. Among this subset, 9.5% experienced stage 1 AKI, 0.1% developed stage 2 AKI, and 1.1% had stage 3 AKI. The factors associated with stage 3 AKI included baseline comorbidities, race, clinical presentation and procedural factors. In the CMS-linked analysis of 62,757 of the patients – which made up about 58.2% of the overall study group – patients with AKI maintained a higher adjusted hazard ratio for mortality after one year than patients who did not develop AKI.

"The vast majority of patients who suffer AKI after TAVR only experience mild renal insufficiency, though patients who developed stage 3 AKI had 7× higher adjusted 1-year mortality compared with those patients who did not develop AKI," the authors conclude.

In a related editorial comment, Ran Kornowski, MD, FACC, et al., outline a multiprong approach toward reducing AKI development following TAVR, stating that "what was not evaluated in this study was the concept of pre-TAVR renal consultation and optimization to reduce AKI risk in patients with [chronic kidney disease] and those at risk of AKI post-TAVR. Second, TAVR operators should aim to offset nephrotoxic risk factors, such as excessive use of radio-contrast during the procedure, avoiding prolonged hemodynamic changes, and implementing a meticulous technique to minimize systemic embolization or bleeding events that can risk AKI. Third, one should avoid using nephrotoxic medications during the peri-procedural period and consult with nephrologists as needed to optimize the cardio-renal management."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Centers for Medicare and Medicaid Services, U.S., Transcatheter Aortic Valve Replacement, Registries, Acute Kidney Injury, National Cardiovascular Data Registries, STS/ACC TVT Registry, Medicare, Renal Insufficiency, Chronic, Hemodynamics

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