Key result
Post-TAVR acute kidney injury is linked to ~7.2-fold higher 1-year dialysis risk.
Why the study?
In patients undergoing TAVR, the impact of AKI on prognosis and especially on future kidney function has been sparsely examined, warranting data from large cohorts.
Does postprocedural acute kidney injury increase the risk of dialysis treatment and all-cause death in patients undergoing transcatheter aortic valve replacement?
Cohort (n=4,091)
Yes
Does postprocedural acute kidney injury increase the risk of dialysis treatment and all-cause death in patients undergoing transcatheter aortic valve replacement?
Hazard Ratio: 7.2 (95% CI 4.1–12.66)
Absolute Event Rate: 9.2% vs 1.4%
p-value: p=<0.001
Acute kidney injury after TAVR strongly predicts future dialysis and mortality, though nearly 75% of survivors will experience complete kidney recovery within 6 months.
BACKGROUND: In patients undergoing transcatheter aortic valve replacement (TAVR), the impact of acute kidney injury (AKI) on the prognosis and especially on future kidney function has been sparsely examined, and data from large cohorts are warranted. METHODS AND RESULTS: With Danish nationwide registries, we identified all patients undergoing TAVR from 2014 to 2021 with no previous dialysis treatment. According to 2 plasma creatinine samples, we identified those suffering a postprocedural AKI within 21 days after TAVR. With 1 year of follow-up, we compared the associated rates of dialysis treatment and death between patients with and without an AKI using multivariable Cox analysis. Finally, according to the lowest recorded creatinine sample, we assessed the kidney function among AKI survivors between 90 and 180 days after the index date. We identified 4091 TAVRs: 193 (4.7%) with AKI (55.4% men; median age, 82 years) and 3898 (95.3%) without AKI (57.0% men; median age, 81 years). Compared with those without AKI, patients with AKI showed increased associated 1-year rates of dialysis treatment (hazard ratio [HR], 7.20 [95% CI, 4.10-12.66]) and death (HR, 2.39 [95% CI, 1.59-3.58]). After 6 months, 74% of AKI survivors had complete kidney recovery, 14.7% had incomplete kidney recovery, 6.3% failed to recover, and 5.1% were on dialysis treatment. CONCLUSIONS: We identified that AKI after TAVR was associated with an increased rate of future dialysis treatment and all-cause death. Among survivors, 74% had complete kidney recovery within 6 months.
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Petersen et al. (2023) conducted a cohort in Severe symptomatic aortic stenosis undergoing TAVR (n=4,091). Acute kidney injury (AKI) post-TAVR vs. No acute kidney injury was evaluated on 1-year rate of dialysis treatment (HR 7.20, 95% CI 4.10-12.66, p=<0.001). Acute kidney injury following transcatheter aortic valve replacement was associated with a significantly increased 1-year rate of dialysis treatment (HR 7.20).
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