Hypertension (OR 2.87), chronic kidney disease (OR 3.27), transapical access (OR 3.45), elevated serum creatinine (OR 2.80), coronary artery disease (OR 1.46), peripheral vascular disease (OR 1.71), prior stroke (OR 1.61), and higher STS score (OR 1.06 per point) independently increased risk of AKI after TAVR.
Meta-Analysis (n=10,353)
Yes
Do specific baseline and procedural risk factors increase the risk of acute kidney injury in patients undergoing transcatheter aortic valve replacement?
Post-TAVR acute kidney injury is significantly driven by baseline cardiovascular and renal comorbidities, as well as transapical access, highlighting the need for targeted renal-protective strategies in high-risk patients.
Effect estimate: OR for multiple risk factors
Objective To delineate risk factors for acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) via a systematic review and meta-analysis. Methods PubMed, Embase, the Cochrane Library, and Web of Science were searched through February 2025 for case-control studies reporting post-TAVR AKI. Two reviewers independently performed study selection, data extraction, and bias assessment. Pooled analyses were conducted with Stata 15.0. Results Thirty-four studies (10,353 patients) met the inclusion criteria; 2,250 patients (21.7%) developed AKI. Univariable meta-analysis implicated multiple comorbid, hemodynamic, and procedural factors [e.g., hypertension, diabetes, coronary and peripheral vascular disease, porcelain aorta, prior PCI, atrial fibrillation, chronic kidney disease (CKD), advanced NYHA class, left ventricular ejection fraction (LVEF) 40%, anemia, diuretic use, transapical/transaortic access, general anesthesia, rapid pacing, bleeding or vascular complications, transfusion, and peri-procedural myocardial infarction or stroke; all p 0.05). Multivariable pooling isolated eight independent predictors: hypertension (OR 2.87), coronary artery disease (1.46), peripheral vascular disease (1.71), prior stroke (1.61), CKD (3.27), elevated serum creatinine (2.80), higher STS score (1.06 per point), and transapical access (3.45). Publication bias was not detected. Conclusions Post-TAVR AKI is chiefly driven by cardiovascular comorbidity and renal impairment, with hypertension, coronary and peripheral vascular disease, prior stroke, CKD, elevated creatinine, high STS score, and transapical access displaying the strongest, independent associations. Awareness of these factors may facilitate peri-procedural risk stratification and targeted renal-protective strategies.
Jiang et al. (Mon,) conducted a meta-analysis in Patients with clinically confirmed aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) with risk of postoperative acute kidney injury (AKI) (n=10,353). Transcatheter aortic valve replacement (TAVR) vs. Patients without AKI following TAVR was evaluated on Development of acute kidney injury (AKI) following TAVR (OR for multiple risk factors). Hypertension (OR 2.87), chronic kidney disease (OR 3.27), transapical access (OR 3.45), elevated serum creatinine (OR 2.80), coronary artery disease (OR 1.46), peripheral vascular disease (OR 1.71), prior stroke (OR 1.61), and higher STS score (OR 1.06 per point) independently increased risk of AKI after TAVR.
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