Persistent acute kidney injury after TAVR was significantly associated with increased 2-year mortality among hospital survivors (HR 2.65; 95% CI 1.51-4.41).
Cohort (n=386)
No
Does persistent acute kidney injury (pAKI) after TAVR increase the risk of 2-year mortality in adult patients?
Persistent acute kidney injury after TAVR is associated with a significantly increased risk of 2-year mortality, with risk factors including diabetes, prior PCI, IABP use, and blood transfusion.
Effect estimate: HR 2.65 (95% CI 1.51-4.41)
Background Acute kidney injury (AKI) and its severity after transcatheter aortic valve replacement (TAVR) have been associated with worse outcomes. Studies have shown that AKI duration (transient or persistent) affects outcomes independently of AKI severity. This study was undertaken to determine the association, risk factors, and outcomes associated with persistent AKI (pAKI) after TAVR. Methods Adult patients undergoing TAVR at Mayo Clinic between January 1, 2008 and June 30, 2014 were enrolled. pAKI was defined as an increased serum creatinine at hospital discharge (≥0.3 mg/dL or ≥50% from baseline). Risk factors associated with pAKI were identified with multivariate logistic regression. Results A total of 386 patients met the inclusion criteria. Fifty patients (13%) had pAKI. Independent risk factors for pAKI on multivariate analysis included diabetes mellitus (odds ratio OR, 2.43; 95% confidence interval CI, 1.29-4.66), prior percutaneous coronary intervention (PCI) (OR, 2.39; 95%CI, 1.24-4.80), intra-aortic balloon pump (IABP) use (OR, 8.14; 95%CI, 1.60-45.78), and blood transfusion (OR, 2.22; 95%CI, 1.15-4.27). Protective factors for pAKI included a higher baseline estimated glomerular filtration rate (eGFR) (OR, 0.83 per 10-mL/min/1.73 m2 increase in eGFR; 95%CI, 0.71-0.99). After adjusting for the Society of Thoracic Surgeons cardiac surgery risk score, pAKI occurrence remained significantly associated with increased 2-year mortality among hospital survivors (hazard ratio, 2.65; 95%CI, 1.51-4.41). Conclusion pAKI was significantly associated with higher mortality risk following TAVR. Baseline eGFR, diabetes mellitus, previous PCI, IABP, and blood transfusion were risk factors for post-procedural pAKI.
Thongprayoon et al. (Tue,) conducted a cohort in Transcatheter aortic valve replacement (n=386). Persistent acute kidney injury (pAKI) vs. No pAKI was evaluated on 2-year mortality among hospital survivors (HR 2.65, 95% CI 1.51-4.41). Persistent acute kidney injury after TAVR was significantly associated with increased 2-year mortality among hospital survivors (HR 2.65; 95% CI 1.51-4.41).