Acute Kidney Injury after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Abstract

Background: The objective of this meta-analysis was to evaluate the risk of acute kidney injury (AKI) in patients who underwent transcatheter aortic valve replacement (TAVR). Methods: A literature search was performed using MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception through October, 2014. Studies that reported relative risks, ORs, or hazard ratios comparing the AKI risk in patients who underwent TAVR versus those who underwent surgical aortic valve replacement were included. We performed the pre-specified sensitivity analysis including only propensity score-based studies. Mortality risk was evaluated among the studies that reported AKI outcome. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Three randomized controlled trials (RCTs) with 1,852 patients and 14 cohort studies with 3,113 patients were analyzed to assess the AKI risk in patients undergoing TAVR. The pooled RRs of AKI in patients undergoing TAVR were 0.65 (95% CI 0.36-1.15, I² = 75%) in the analysis of RCTs and propensity score-based studies and 0.76 (95% CI 0.44-1.34, I² = 79%) in the analysis of observational studies. Sensitivity analysis in RCTs and propensity score-based studies using a standard AKI definition demonstrated a significant association between TAVR and lower AKI risk (RR 0.35, 95% CI 0.25-0.50, I² = 0%). Our meta-analyses of RCTs and propensity score-based studies did not find associations between TAVR and reduced risks of severe AKI requiring dialysis (RR 0.82, 95% CI 0.38-1.79, I² = 63%). Conclusions: Our meta-analysis demonstrates an association between TAVR and lower AKI risk.

Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

“…We did, however, find a significant decrease in acute renal failure and an increase in rates of pacemaker implantations in the TAVR group as compared to SAVR group. Although the incidence of acute renal failure has been examined in other trials (21)(22)(23)(24), this is the first instance where a large data set has detected a significant benefit of TAVR over SAVR in a non-high risk population. Our data suggests that TAVR may result in improved neurologic outcomes and reduced post-procedure MIs but this study lacked the power to demonstrate a statistically significant difference.…”

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

“…90,[92][93][94][96][97][98][99][100] Patients requiring renal replacement therapy (RRT) after TAVR had on average a 3-fold increase in 30-day mortality and a 3.3-fold increase in 1-year mortality as compared with patients with AKI of lower severity. In a recent meta-analysis of randomized controlled trials in TAVR, there was no association between TAVR and reduced risks of short term mortality (<1 year, RR 0.84, 95% CI 0.56-1.26); 102 patients that developed AKI following TAVR stayed 1.5 to 2 fold longer in hospital than patients without AKI. A recent study 120 looked at incidence, causes and predictors of early (<=30 days) and late unplanned hospital re-admissions after TAVR; CKD (p=0.013) was found to be associated with late unplanned re-admission after TAVR.…”

“…A recent study 120 looked at incidence, causes and predictors of early (<=30 days) and late unplanned hospital re-admissions after TAVR; CKD (p=0.013) was found to be associated with late unplanned re-admission after TAVR. Further to the above, a metaanalysis suggested that 30-day mortality was 7.8%-29% for patients with AKI following TAVR and 5.5%-46% for those with AKI after SAVR, the rates being 2-16 times higher than in patients without AKI after the procedure 102 .…”

Changes in kidney function among patients undergoing transcatheter aortic valve replacement

“…Despite increasing evidence of treating intermediate surgical-risk patients (7)(8)(9), many patients elected for TAVR commonly have renal insufficiency (11,12), one of important predictors for acute kidney injury (AKI) development (13). In addition, AKI following TAVR is very prevalent, varying from 15% up to 57% (10,11,(14)(15)(16). Although patients with chronic kidney disease (CKD) carry a higher risk of developing AKI, improvement in estimated glomerular filtration rate (eGFR) following surgical aortic valve replacements (SAVRs) has been demonstrated in patients with CKD after relief of severe aortic valve diseases (17,18).…”