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Incidence and Predictors of Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Implantation
Study Questions:
What are the incidence, predictors, and implications of acute kidney injury (AKI) in patients undergoing transcatheter aortic valve implantation (TAVI)?
Methods:
The authors reported the outcome of 234 consecutive patients who underwent TAVI with the Medtronic CoreValve System (Medtronic CoreValve, Minneapolis, MN) or Edwards SAPIEN (Edwards Lifesciences, Inc., Irvine, CA) heart valve at their center. AKI was defined as an increase in serum creatinine of >1.5 or glomerular filtration rate decrease of 25%. Patients with preoperative end-stage renal failure requiring dialysis were excluded.
Results:
AKI occurred in 46 (19.6%) of 234 patients, and dialysis was required in 24 (10.3%) patients. Patients with AKI had higher in-hospital mortality compared with those without AKI (15.2% vs. 7.7%, p = 0.015). Preoperative serum creatinine, preoperative blood urea nitrogen, peripheral vascular disease, and blood transfusion were associated with AKI, although preoperative serum creatinine level was the only independent predictor of AKI (odds ratio, 3.7; 95% confidence interval, 1.24-11.3; p = 0.019).
Conclusions:
The authors concluded that AKI is common in patients undergoing TAVI, and is associated with an increased risk of in-hospital mortality.
Perspective:
The procedural outcome of TAVI has been improving with refinement in technology and technique. AKI is relatively common in this population, and this in part related to the greater prevalence of prior renal dysfunction and other comorbidities. Further studies are warranted to assess the mechanism of AKI in association with TAVI so that appropriate preventive strategies can be developed.
Keywords: Incidence, Hospital Mortality, Kidney Function Tests, Kidney Failure, Chronic, Acute Kidney Injury, Glomerular Filtration Rate, Renal Insufficiency, Chronic, Peripheral Vascular Diseases
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