Kliuk-Ben Bassat O, Sadon S, Sirota S, Steinvil A, Konigstein M, Halkin A, Bazan S, Grupper A, Banai S, Finkelstein A, Arbel Y. Assessment of Kidney Function After Transcatheter Aortic Valve Replacement.
Can J Kidney Health Dis 2021;
8:20543581211018029. [PMID:
34158963 PMCID:
PMC8182180 DOI:
10.1177/20543581211018029]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background:
Transcatheter aortic valve replacement (TAVR), although associated with an
increased risk for acute kidney injury (AKI), may also result in improvement
in renal function.
Objective:
The aim of this study is to evaluate the magnitude of kidney function
improvement (KFI) after TAVR and to assess its significance on long-term
mortality.
Design:
This is a prospective single center study.
Setting:
The study was conducted in cardiology department, interventional unit, in a
tertiary hospital.
Patients:
The cohort included 1321 patients who underwent TAVR.
Measurements:
Serum creatinine level was measured at baseline, before the procedure, and
over the next 7 days or until discharge.
Methods:
Kidney function improvement was defined as the mirror image of AKI, a
reduction in pre-procedural to post-procedural minimal creatinine of more
than 0.3 mg/dL, or a ratio of post-procedural minimal creatinine to
pre-procedural creatinine of less than 0.66, up to 7 days after the
procedure. Patients were categorized and compared for clinical endpoints
according to post-procedural renal function change into 3 groups: KFI, AKI,
or preserved kidney function (PKF). The primary endpoint was long-term
all-cause mortality.
Results:
The incidence of KFI was 5%. In 55 out of 66 patients patients, the
improvement in kidney function was minor and of unclear clinical
significance. Acute kidney injury occurred in 19.1%. Estimated glomerular
filtration rate (eGFR) <60 mL/min/1.73 m2 was a predictor of
KFI after multivariable analysis (odds ratio = 0.93 to develop KFI;
confidence interval [95% CI]: 0.91-0.95, P < .001).
Patients in the KFI group had a higher Society of Thoracic Surgery (STS)
score than other groups. Mortality rate did not differ between KFI group and
PKF group (43.9% in KFI group and 33.8% in PKF group) but was significantly
higher in the AKI group (60.7%, P < .001).
Limitations:
The following are the limitations: heterozygous definitions of KFI within
different studies and a single center study. Although data were collected
prospectively, analysis plan was defined after data collection.
Conclusions:
Improvement in kidney function following TAVR was not a common phenomenon in
our cohort and did not reduce overall mortality rate.
Collapse