Factors Contributing to Acute Kidney Injury and the Impact on Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement

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• 作者：James A Crowhurst ; BSc^a ; ^b ; ^{Jimcrowhurst@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; ^{Jim_Crowhurst@health.qld.gov.au" class="auth_mail" title="E-mail the corresponding author} ; Michael Savage ; BAppScHMS^a ; Vijayakumar Subban ; MD DM^a ; Alexander Incani ; MB BS FRACP FCSANZ^a ; ^b ; Owen C Raffel ; MB FRACP FCSANZ^a ; ^b ; Karl Poon ; MB BS FRACP FCSANZ^a ; ^b ; Dale Murdoch ; MB BS FRACP^a ; ^b ; Ramkrishna Saireddy ; MB BS MRCP FRACP^a ; Andrew Clarke ; MB BS FRACS FCSANZ^a ; Constantine Aroney ; MD BS FRACP FCSANZ^a ; ^b ; ^c ; Nicholas Bett ; MB BS FRACP FCSANZ^a ; Darren L Walters ; MB BS MPhil FRACP FSCAI FCSANZ^a ; ^b
• 关键词：TAVR ; Acute kidney injury ; Contrast media ; Renal failure ; Chronic kidney disease ; Co-morbidities
• 刊名：Heart, Lung and Circulation
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：25
• 期：3
• 页码：282-289
• 全文大小：477 K

文摘

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.