Author + information
- 1University of Vermont Medical center, Burlington, Vermont, United States
- 2University of Vermont Medical Center, Burlington, Vermont, United States
- 3The University of Vermont, Department of Mathematics and Statistics, Burlington, Vermont, United States
- 4University of Vermont, Burlington, Vermont, United States
- 5University of Vermont College of Medicine, Burlington, Vermont, United States
Acute Kidney Injury (AKI) after TAVR is associated with increased mortality. As significant hemodynamic improvement may occur with relief of aortic stenosis, we hypothesized that TAVR patients may demonstrate the opposite phenomena: Acute Kidney Recovery (AKR). We studied the incidence and predictors of AKR in post-TAVR patients.
366 consecutive patients underwent TAVR (January 2012 - January 2017) at a single center, excluding dialysis patients. We defined AKR as 25% improvement in GFR at 48 hours after TAVR. AKI-1 was defined as increase in creatinine of ≥ 0.3 mg/dL at 48 hours (VARC-2). Patients were categorized in 3 groups: AKR (≥25% increase in GFR), unchanged GFR and AKI-2 (inverse definition of AKR, ≥25% decrease in GFR). Demographics, procedural data and hospital outcomes were compared between 3 groups. Multivariable logistic regression was used to define independent predictors of AKR.
AKR occurred in 1/3 of patients. AKI-1 (delta creatinine) occurred in 13% of patients while AKI-2 (delta GFR) occurred similarly in 15% of patients. AKR and AKI occurred most frequently among patients with chronic kidney disease (CKD: GFR < 60 ml/min)(Figure). Baseline CKD was observed in 74% of patients with both AKI and AKR but only 56% of patients with stable renal function (P< 0.001). Independent predictors of AKR by multivariable analysis were: male sex, lack of chronic beta-blocker utilization, and presence of CKD. Notably, left ventricular dysfunction and contrast volume were not predictive of AKR. Transfusion occurred less frequently among patients with AKR as compared to patients with AKI-2; (11% vs 26%, p=0.03). Death occurred in 0% of AKR patients vs 9.3% of AKI-2 patients (p< 0.01).
To our knowledge, this is the first report of AKR after TAVR. AKR occurs in 1/3 of patients undergoing TAVR. Patients with CKD, male sex and lack of pre-TAVR beta-blockade were more likely to demonstrate acute kidney recovery. Further study of AKR as a prognostic indicator after TAVR is warranted.
STRUCTURAL: Valvular Disease: Aortic