Factors contributing to acute kidney injury and the impact on mortality in patients undergoing transcatheter aortic valve replacement

Crowhurst, James A., Savage, Michael, Subban, Vijayakumar, Incani, Alexander, Raffel, Owen C., Poon, Karl, Murdoch, Dale, Saireddy, Ramkrishna, Clarke, Andrew, Aroney, Constantine, Bett, Nicholas and Walters, Darren L. (2016) Factors contributing to acute kidney injury and the impact on mortality in patients undergoing transcatheter aortic valve replacement. Heart Lung and Circulation, 25 3: 282-289. doi:10.1016/j.hlc.2015.06.832


Author Crowhurst, James A.
Savage, Michael
Subban, Vijayakumar
Incani, Alexander
Raffel, Owen C.
Poon, Karl
Murdoch, Dale
Saireddy, Ramkrishna
Clarke, Andrew
Aroney, Constantine
Bett, Nicholas
Walters, Darren L.
Title Factors contributing to acute kidney injury and the impact on mortality in patients undergoing transcatheter aortic valve replacement
Journal name Heart Lung and Circulation   Check publisher's open access policy
ISSN 1444-2892
1443-9506
Publication date 2016-03-01
Sub-type Article (original research)
DOI 10.1016/j.hlc.2015.06.832
Open Access Status Not Open Access
Volume 25
Issue 3
Start page 282
End page 289
Total pages 8
Place of publication Chatswood, NSW, Australia
Publisher Elsevier Australia
Language eng
Formatted abstract
Background:  Transcatheter aortic valve replacement (TAVR) patients are at a high risk of acute kidney injury (AKI). This study aimed to investigate AKI and the relationship with iodinated contrast media (ICM), whether there are significant pre- or peri- procedural variables predicting AKI, and whether AKI impacts on hospital length of stay and mortality.

Methods:  Serum creatinine (SC) levels pre- and post- (peak) TAVR were recorded in 209 consecutive TAVR patients. AKI was defined by the Valve Academic Research Consortium 2 (VARC2) criteria. Baseline characteristics, procedural variables, hospital length of stay (LOS) and mortality at 72 hours, 30 days and one year were analysed.

Results:  Eighty-two of 209 (39%) patients suffered AKI. Mean ICM volume was 228cc, with no difference between patients with AKI and those with no AKI (227cc (213-240(95%CI)) vs 231cc (212-250) p=0.700)). Univariate and multivariate analysis demonstrated that chronic kidney disease, respiratory failure, previous stroke, the need for blood transfusion and valve repositioning were all predictors of AKI. Acute kidney injury increased LOS (5.6 days (3.8 - 7.5) vs 3.2 days (2.6 - 3.9) no AKI (P=0.004)) but was not linked to increased mortality. Mortality rates did increase with AKI severity.

Conclusion:  Acute kidney injury is a common complication of TAVR. The severity of AKI is important in determining mortality. Acute kidney injury appears to be independent of ICM use but pre-existing renal impairment and respiratory failure were predictors for AKI. Transcatheter aortic valve replacement device repositioning or retrieval was identified as a new risk factor impacting on AKI.
Keyword Acute kidney injury
Chronic kidney disease
Co-morbidities
Contrast media
Renal failure
TAVR
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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