Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement
Why the study?
Does TAVI reduce the incidence of acute kidney injury compared to SAVR in patients with severe aortic stenosis and pre-procedural chronic kidney disease?
Population
317 patients with severe aortic stenosis, including 213 undergoing TAVI and 104 contemporary patients with…
Comparison
Transcatheter aortic valve implantation (TAVI) vs Surgical aortic valve replacement in the…
Design
Cohort
Follow-up
index hospitalization
Authors
Discussion
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Member takes
Implication
May favor TAVI to lower AKI risk in CKD; hypothesis-generating pending randomized confirmation.
Key Points
- To determine the incidence, risk factors, and prognostic impact of acute kidney injury following transcatheter aortic valve implantation, and compare these outcomes to surgical aortic valve replacement in patients with baseline chronic kidney disease.
- Evaluated 213 patients (mean age 82 ± 8 years) undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis, defining acute kidney injury (AKI) as a >25% reduction in eGFR within 48 hours or dialysis requirement during hospitalization.
- Compared 119 TAVI patients with baseline chronic kidney disease (eGFR <60 mL/min/1.73 m²) against 104 contemporary chronic kidney disease patients who underwent isolated surgical aortic valve replacement (SAVR), adjusting outcomes using propensity score analysis.
- Post-TAVI AKI occurred in 11.7% of patients (1.4% requiring hemodialysis) and independently increased in-hospital mortality risk (OR 4.14, 95% CI 1.42–12.13), with hypertension (OR 4.66, 95% CI 1.04–20.87), COPD (OR 2.64, 95% CI 1.10–6.36), and perioperative blood transfusion (OR 3.47, 95% CI 1.30–9.29) acting as independent predictors.
- Among patients with chronic kidney disease, TAVI resulted in a significantly lower incidence of AKI than SAVR (9.2% vs. 25.9%; P=0.001, adjusted P=0.014) and a lower requirement for hemodialysis (2.5% vs. 8.7%).
Structured PICO
Does TAVI reduce the incidence of acute kidney injury compared to SAVR in patients with severe aortic stenosis and pre-procedural chronic kidney disease?
P
Population
317 patients with severe aortic stenosis, including 213 undergoing TAVI (mean age 82 +/- 8 years) and 104 contemporary patients with pre-procedural CKD (eGFR <60 mL/min/1.73 m2) undergoing isolated SAVR.
I
Intervention
Transcatheter aortic valve implantation (TAVI)
C
Comparator
Surgical aortic valve replacement (SAVR) in the subgroup of patients with pre-procedural chronic kidney disease
O
Outcome
Incidence of acute kidney injury (AKI), defined as a reduction of >25% in estimated glomerular filtration rate (eGFR) within 48 h following the procedure or the need for haemodialysis during index hospitalizationsafety
TAVI is associated with a significantly lower risk of acute kidney injury compared to SAVR in patients with severe aortic stenosis and pre-existing chronic kidney disease.
Cite This Study
Bagur et al. (2009) studied this question.