In recent years, the kidney function after Transcatheter Aortic Valve Replacement (TAVR) has gradually become a hot spot that arouse extensive attention.Our study is aimed to evaluate the incidence and predictors of acute kidney recovery (AKR) after TAVR.
Methods
A total of 102 patients undergoing TAVR in Beijing Anzhen Hospital from June 2021 to March 2022 were enrolled in our study. Patients were divided into AKR group (n = 54), unchanged group (n = 40) and acute kidney injury (AKI) group (n = 8) based on the percent change of estimated glomerular filtration rate (eGFR). Univariate analysis was used to compare the differences in general clinical characteristics and other related indicators between the three groups to analyze the risk factors of AKR.
Results
The incidence of AKR was 53% (54/102) after TAVR. Multivariate analysis showed that the incidence of age and proportion of severe NYHA class (III or IV) was significantly higher in the AKR group while renal dysfunction (eGFR <60 mL/min/1.73 m2) was lower. Besides, fluid management/volume therapy was significantly different among the three groups.
Conclusions
AKR is a generalizable phenomenon occurring frequently after TAVR. The age, proportion of severe NYHA class and the baseline renal function are independent predictors of AKR events in patients with severe aortic stenosis undergoing TAVR.
RosnerMHOkusaMD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol. 2006;1(1):19–32.
2.
ThongprayoonCCheungpasitpornWAkhoundiA, et al.Actual versus ideal body weight for acute kidney injury diagnosis and classification in critically ill patients. BMC Nephrol2014;15: 176.
3.
AbbasSQayumIWahidR, et al.Acute Kidney Injury In Transcatheter Aortic Valve Replacement. Cureus2021; 13(5): e15154.
4.
ChandrasekharJSartoriSMehranR, et al.Incidence, predictors, and outcomes associated with acute kidney injury in patients undergoing transcatheter aortic valve replacement: from the BRAVO-3 randomized trial. Clin Res Cardiol2021; 110(5): 649–657.
5.
FerroCJLawJPDoshiSN, et al.Dialysis following transcatheter aortic valve replacement: risk factors and outcomes: an analysis from the UK TAVI (Transcatheter aortic valve implantation) Registry. JACC Cardiovasc Interv2017; 10(20): 2040–2047.
6.
NajjarMSalnaMGeorgeI. Acute kidney injury after aortic valve replacement: incidence, risk factors and outcomes. Expert Rev Cardiovasc Ther2015; 13(3): 301–316.
7.
O'ConnorGTPlumeSKOlmsteadEM, et al.A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group. JAMA1991; 266(6): 803–809.
8.
LeonMBSmithCRMackM, et al.Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med2010; 363(17): 1597–1607.
9.
MakkarRRFontanaGPJilaihawiH, et al.Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med2012; 366(18): 1696–1704.
10.
AdamsDHPopmaJJReardonMJ, et al.Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med2014; 370(19): 1790–1798.
11.
NishimuraRAOttoCMBonowRO, et al.2017 AHA/ACC Focused Update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Circulation2017; 135(25): e1159–e1195.
12.
BaumgartnerHFalkVBaxJJ, et al.2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J2017; 38(36): 2739–2791.
13.
MackMJLeonMBSmithCR, et al5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet2015; 385(9986): 2477–2484.
14.
MakkarRRThouraniVHMackMJ, et alFive-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med2020; 382(9): 799–809.
15.
AzarbalAMalenkaDJHuangYL, et al.Recovery of kidney dysfunction after transcatheter aortic valve implantation (from the Northern New England cardiovascular disease study group). Am J Cardiol2019; 123(3): 426–433.
16.
LahoudRButzelDWParseeA, et al.Acute kidney recovery in patients who underwent transcatheter versus surgical aortic valve replacement (from the Northern New England cardiovascular disease study group). Am J Cardiol2020; 125(5): 788–794.
17.
EvansJDykeKG. Characterization of the conjugation system associated with the Staphylococcus aureus plasmid pJE1. J Gen Microbiol. 1988;134(1):1–8.
18.
LeveyASStevensLASchmidCH, et al.A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–612.
19.
OkohAKKambizKUnnikrishnanD, et al.Effect of transcatheter aortic valve implantation on renal function in patients with previous renal dysfunction. Am J Cardiol2019; 124(1): 85–89.
20.
CribierAEltchaninoffHBashA, et al.Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation2002; 106(24): 3006–3008.
21.
ElhmidiYBleizifferSDeutschMA, et al.Acute kidney injury after transcatheter aortic valve implantation: incidence, predictors and impact on mortality. Arch Cardiovasc Dis2014; 107(2): 133–139.
22.
PeillexMMarchandotBMatsushitaK, et al.Acute kidney injury and acute kidney recovery following transcatheter aortic valve replacement. PLoS One2021; 16(8): e0255806.
23.
JhaveriKDSaratzisANWanchooR, et al.Endovascular aneurysm repair (EVAR)- and transcatheter aortic valve replacement (TAVR)-associated acute kidney injury. Kidney Int2017; 91(6): 1312–1323.
24.
AlassarARoyDAbdulkareemN, et al.Acute kidney injury after transcatheter aortic valve implantation: incidence, risk factors, and prognostic effects. Innovations2012; 7(6): 389–393.
25.
ElhmidiYBleizifferSPiazzaN, et al.Incidence and predictors of acute kidney injury in patients undergoing transcatheter aortic valve implantation. Am Heart J2011; 161(4): 735–739.
26.
NuisRJMVan MieghemNMTzikasA, et al.Frequency, determinants, and prognostic effects of acute kidney injury and red blood cell transfusion in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv2011; 77(6): 881–889.
27.
BagurRWebbJGNietlispachF, et al.Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J2010; 31(7): 865–874.
28.
Kliuk-Ben BassatOFinkelsteinABazanS, et al.Acute kidney injury after transcatheter aortic valve implantation and mortality risk-long-term follow-up. Nephrol Dial Transplant2020; 35(3): 433–438.
29.
ArsalanMSquiersJJFarkasR, et al.Prognostic usefulness of acute kidney injury after transcatheter aortic valve replacement. Am J Cardiol2016; 117(8): 1327–1331.
30.
ZivkovicNElbaz-GreenerGQiuF, et al.Bedside risk score for prediction of acute kidney injury after transcatheter aortic valve replacement. Open Heart2018; 5(1): e000777.
31.
AdamoMProviniMFiorinaC, et al.Interaction between severe chronic kidney disease and acute kidney injury in predicting mortality after transcatheter aortic valve implantation: Insights from the Italian Clinical Service Project. Catheter Cardiovasc Interv2020; 96(7): 1500–1508.
32.
BeoharNDoshiDThouraniV, et al.Association of transcatheter aortic valve replacement with 30-day renal function and 1-year outcomes among patients presenting with compromised baseline renal function: experience from the PARTNER 1 trial and registry. JAMA Cardiol2017; 2(7): 742–749.
33.
AzarbalALeadholmKLAshikagaT, et al.Frequency and prognostic significance of acute kidney recovery in patients who underwent transcatheter aortic valve implantation. Am J Cardiol2018; 121(5): 634–641.
34.
KhawajaMZThomasMJoshiA, et al.The effects of VARC-defined acute kidney injury after transcatheter aortic valve implantation (TAVI) using the Edwards bioprosthesis. EuroIntervention. 2012;8(5):563–570.
35.
SinningJMGhanemASteinhauserH, et al.Renal function as predictor of mortality in patients after percutaneous transcatheter aortic valve implantation. JACC Cardiovasc Interv2010; 3(11): 1141–1149.
36.
OttoCM. Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol2006; 47(11): 2141–2151.
37.
EweSHAjmone MarsanNPepiM, et al.Impact of left ventricular systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation for severe aortic stenosis. Am Heart J2010; 160(6): 1113–1120.
38.
VoigtlanderLSchewelJMartinJ, et al.Impact of kidney function on mortality after transcatheter valve implantation in patients with severe aortic valvular stenosis. Int J Cardiol2015; 178: 275–281.
39.
PulsMBleckmannAJacobshagenC, et al., [Diabetes increases short- and long-term mortality after transcatheter aortic valve implantation (TAVI)]. Dtsch Med Wochenschr2014; 139(16): 822–828.
40.
KongWYYongGIrishA. Incidence, risk factors and prognosis of acute kidney injury after transcatheter aortic valve implantation. Nephrology2012; 17(5): 445–451.
41.
SaiaFCiucaCTaglieriN, et al.Acute kidney injury following transcatheter aortic valve implantation: incidence, predictors and clinical outcome. Int J Cardiol2013; 168(2): 1034–1040.
42.
SchewelDZavarehMSchewelJ, et al.Impact of interaction of diabetes mellitus and impaired renal function on prognosis and the incidence of acute kidney injury in patients undergoing transcatheter aortic valve replacement (TAVR). Int J Cardiol2017; 232: 147–154.
43.
FoxCSLarsonMGLeipEP, et al.Predictors of new-onset kidney disease in a community-based population. JAMA2004; 291(7): 844–850.
44.
RibeiroHBNombela-FrancoLUrenaM, et al.Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv2013; 6(5): 452–461.
45.
JilaihawiHKashifMFontanaG, et al.Cross-sectional computed tomographic assessment improves accuracy of aortic annular sizing for transcatheter aortic valve replacement and reduces the incidence of paravalvular aortic regurgitation. J Am Coll Cardiol2012; 59(14): 1275–1286.
46.
BerkovitchABarbashIM. The gender paradox in TAVR. Ann Transl Med2017; 5(16): 329.
47.
ChandrasekharJDangasGMehranR. Valvular heart disease in women, differential remodeling, and response to new therapies. Curr Treat Options Cardiovasc Med2017; 19(9): 74.
48.
MentiasAGirotraSDesaiMY, et al.Incidence, Predictors, and outcomes of endocarditis after transcatheter aortic valve replacement in the United States. JACC Cardiovasc Interv2020; 13(17): 1973–1982.
