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Incidence, risk factors and prognosis of acute kidney injury after transcatheter aortic valve implantation.
Nephrology (Carlton). 2012 Jul; 17(5):445-51.N

Abstract

AIM

Transcatheter aortic valve implantation (TAVI) poses a significant risk of acute kidney injury (AKI). Little is known of the impact of TAVI and AKI on long-term kidney function and health cost. We explored the predictive factors and prognostic implications of AKI following TAVI.

METHODS

Single-centre retrospective analysis of 52 elderly patients undergoing TAVI was conducted. The primary endpoint was renal outcome which included the incidence of AKI and 12-month renal function after TAVI. Secondary endpoints were mortality, the length of hospital stay (LOS) and cost.

RESULTS

AKI occurred in 15/52 (28.8%) patients (mean age 84 ± 6) and three patients (6%) required dialysis. Patients with AKI (AKI+) had greater comorbidity (diabetes and cerebrovascular disease) and a trend towards reduced estimated glomerular filtration rate (eGFR) at baseline compared with those without AKI (56.6 vs AKI-: 65.7 mL/min per 1.73 m(2) , P = 0.07). Following TAVI, AKI- patients experienced an immediate improvement in eGFR, which remained significantly higher at all time points compared with AKI+ patients (70.4 vs 46.9 at 6 months and 73.7 vs 53.0 at 12 months, P < 0.001). Cumulative mortality for AKI+versus AKI- group was 26.7% and 2.7% (P = 0.006). LOS doubled (P < 0.001) and average hospitalization cost per patient was 1.5 times higher in the AKI+ group (P < 0.001). Independent predictors of AKI were peri-procedural blood transfusion (OR: 2.4, 95% CI: 2.0-3.1), trans-apical approach (OR: 9.3, 95% CI: 4.3-23.7) and hypertension (OR: 6.4, 95% CI: 2.9-17.3).

CONCLUSION

AKI developed in 28.8% of patients after TAVI and was associated with procedural technique and transfusion requirement, and an increased LOS and mortality. However, most patients achieved a significant and sustained improvement in eGFR.

Authors+Show Affiliations

Department of Nephrology and Transplantation, Royal Perth Hospital Interventional Cardiology & High Risk Aortic Stenosis State Service WA, Royal Perth Hospital, Perth, Western Australia, Australia.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22390156

Citation

Kong, Wai Y., et al. "Incidence, Risk Factors and Prognosis of Acute Kidney Injury After Transcatheter Aortic Valve Implantation." Nephrology (Carlton, Vic.), vol. 17, no. 5, 2012, pp. 445-51.
Kong WY, Yong G, Irish A. Incidence, risk factors and prognosis of acute kidney injury after transcatheter aortic valve implantation. Nephrology (Carlton). 2012;17(5):445-51.
Kong, W. Y., Yong, G., & Irish, A. (2012). Incidence, risk factors and prognosis of acute kidney injury after transcatheter aortic valve implantation. Nephrology (Carlton, Vic.), 17(5), 445-51. https://doi.org/10.1111/j.1440-1797.2012.01593.x
Kong WY, Yong G, Irish A. Incidence, Risk Factors and Prognosis of Acute Kidney Injury After Transcatheter Aortic Valve Implantation. Nephrology (Carlton). 2012;17(5):445-51. PubMed PMID: 22390156.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence, risk factors and prognosis of acute kidney injury after transcatheter aortic valve implantation. AU - Kong,Wai Y, AU - Yong,Gerald, AU - Irish,Ashley, PY - 2012/3/7/entrez PY - 2012/3/7/pubmed PY - 2012/10/30/medline SP - 445 EP - 51 JF - Nephrology (Carlton, Vic.) JO - Nephrology (Carlton) VL - 17 IS - 5 N2 - AIM: Transcatheter aortic valve implantation (TAVI) poses a significant risk of acute kidney injury (AKI). Little is known of the impact of TAVI and AKI on long-term kidney function and health cost. We explored the predictive factors and prognostic implications of AKI following TAVI. METHODS: Single-centre retrospective analysis of 52 elderly patients undergoing TAVI was conducted. The primary endpoint was renal outcome which included the incidence of AKI and 12-month renal function after TAVI. Secondary endpoints were mortality, the length of hospital stay (LOS) and cost. RESULTS: AKI occurred in 15/52 (28.8%) patients (mean age 84 ± 6) and three patients (6%) required dialysis. Patients with AKI (AKI+) had greater comorbidity (diabetes and cerebrovascular disease) and a trend towards reduced estimated glomerular filtration rate (eGFR) at baseline compared with those without AKI (56.6 vs AKI-: 65.7 mL/min per 1.73 m(2) , P = 0.07). Following TAVI, AKI- patients experienced an immediate improvement in eGFR, which remained significantly higher at all time points compared with AKI+ patients (70.4 vs 46.9 at 6 months and 73.7 vs 53.0 at 12 months, P < 0.001). Cumulative mortality for AKI+versus AKI- group was 26.7% and 2.7% (P = 0.006). LOS doubled (P < 0.001) and average hospitalization cost per patient was 1.5 times higher in the AKI+ group (P < 0.001). Independent predictors of AKI were peri-procedural blood transfusion (OR: 2.4, 95% CI: 2.0-3.1), trans-apical approach (OR: 9.3, 95% CI: 4.3-23.7) and hypertension (OR: 6.4, 95% CI: 2.9-17.3). CONCLUSION: AKI developed in 28.8% of patients after TAVI and was associated with procedural technique and transfusion requirement, and an increased LOS and mortality. However, most patients achieved a significant and sustained improvement in eGFR. SN - 1440-1797 UR - https://www.unboundmedicine.com/medline/citation/22390156/Incidence_risk_factors_and_prognosis_of_acute_kidney_injury_after_transcatheter_aortic_valve_implantation_ L2 - https://doi.org/10.1111/j.1440-1797.2012.01593.x DB - PRIME DP - Unbound Medicine ER -