Changes in kidney function among patients undergoing transcatheter aortic valve replacement

Cheungpasitporn, Wisit; Kittanamongkolchai, Wonngarm; Srivali, Narat; Greason, Kevin L.; Kashani, Kianoush

doi:10.15171/jrip.2017.41

Cited by 5 publications

(6 citation statements)

References 35 publications

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“…Conversely, improvement in kidney function at discharge was predictive of good improvement in kidney function at 1 year. These results are supported by Thongprayoon et al, who found greater eGFR improvement 6 months after TAVI in patients with severe CKD without AKI than in those with AKI after TAVI [19]. Other predictors of longterm eGFR improvement (significant or with significant trends) in our univariate analysis, but not in the multivariable analysis, were absence of diabetes, peripheral arterial disease, ischaemic cardiomyopathy, chronic pulmonary disease and female sex.…”

Section: Discussionsupporting

confidence: 88%

“…At last, relief of chronic cardiorenal syndrome with chronic systemic inflammation may last long beyond 1 month after aortic valve replacement. As with our study, two other studies have shown kidney function improvement beyond 1 month after TAVI, but did not report the number of patients with CKD stage 3−5 or the number lost to follow-up [19,20].…”

Section: Discussionsupporting

confidence: 47%

“…Those patients may have had less care because of an improvement in eGFR immediately after TAVI. Moreover, we investigated patients with more severe CKD, excluding CKD stage 3a and including CKD stages 4-5, which is the population that has recently been shown to derive the most benefit to kidney function [18,19]. At last, relief of chronic cardiorenal syndrome with chronic systemic inflammation may last long beyond 1 month after aortic valve replacement.…”

Section: Discussionmentioning

confidence: 99%

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Evolution of chronic kidney disease after surgical aortic valve replacement or transcatheter aortic valve implantation

Reuillard

Garrouste

Pereira³

et al. 2019

Archives of Cardiovascular Diseases

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

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Evolution of chronic kidney disease after surgical aortic valve replacement or transcatheter aortic valve implantation

Reuillard

Garrouste

Pereira³

et al. 2019

Archives of Cardiovascular Diseases

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“…Although TAVR is considered a less invasive treatment compared with SAVR, the one and two year mortality following TAVR is still considerable at 24% and 34%, respectively [ 8 , 9 ]. Acute kidney injury (AKI) after TAVR is common with a varied reported incidence ranging from 15% to 57% [ 2 , 6 , 10 , 11 ]. Studies have demonstrated significant associations between AKI and decreased survival in patients undergoing TAVR [ 7 , 10 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Association of frailty status with acute kidney injury and mortality after transcatheter aortic valve replacement: A systematic review and meta-analysis

et al. 2017

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ObjectiveFrailty is a common condition in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). The aim of this systematic review was to assess the impact of frailty status on acute kidney injury (AKI) and mortality after TAVR.MethodsA systematic literature search was conducted using MEDLINE, EMBASE, and Cochrane databases from the inception through November 2016. The protocol for this study is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42016052350). Studies that reported odds ratios, relative risks or hazard ratios comparing the risk of AKI after TAVR in frail vs. non-frail patients were included. Mortality risk was evaluated among the studies that reported AKI-related outcomes. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.ResultsEight cohort studies with a total of 10,498 patients were identified and included in the meta-analysis. The pooled RR of AKI after TAVR among the frail patients was 1.19 (95% CI 0.97–1.46, I2 = 0), compared with non-frail patients. When the meta-analysis was restricted only to studies with standardized AKI diagnosis according to Valve Academic Research Consortium (VARC)-2 criteria, the pooled RRs of AKI in frail patients was 1.16 (95% CI 0.91–1.47, I2 = 0). Within the selected studies, frailty status was significantly associated with increased mortality (RR 2.01; 95% CI 1.44–2.80, I2 = 58).ConclusionThe findings from our study suggest no significant association between frailty status and AKI after TAVR. However, frailty status is associated with mortality after TAVR and may aid appropriate patient selection for TAVR.

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“…There is, however, suggestion that TAVR may lead to improvement in renal function after relief of AS leading to subsequent improvement in cardiac output with increased renal perfusion and decreased renal congestion. 11,18,[20][21][22][23][24] Nevertheless, AKI and worsening renal function at 30 days both portend poor clinical outcomes 12,20,[25][26][27][28][29] after TAVR.…”

Section: Introductionmentioning

confidence: 99%

Association between mid‐term worsening renal function and mortality after transcatheter aortic valve replacement in patients with chronic kidney disease

Phan

Lee

Aharonian

et al. 2020

Cathet Cardio Intervent

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Introduction Chronic kidney disease (CKD), acute kidney injury (AKI) and worsening renal function at 30 days after transcatheter aortic valve replacement (TAVR) portend poor outcomes. We sought to evaluate the association between worsening renal function at 3–6 months and mortality among patients with baseline renal dysfunction undergoing TAVR. Methods This is a retrospective study of patients with glomerular filtration rate (GFR) < 60 ml/min undergoing TAVR between June 2011 and March 2019 at the Regional Cardiac Catheterization Lab at Kaiser Permanente Los Angeles. Worsening renal function at 3–6 months post‐TAVR was defined as: increase in serum creatinine >1.5 times compared to baseline, absolute increase of ≥0.3 mg/dl, or initiation of dialysis. Results Of 683 patients reviewed, 176 were included in the analysis (median age 84 [IQR 79–88] years, 56% female). Of these, 27 (15.3%) had worsening renal function. AKI post‐TAVR (OR 2.9, 95% CI 1.1–7.4, p = .03) and transfusion of ≥4 units red blood cells (OR 8.4, 95% CI 1.2–59, p = .03) were independent predictors of worsening renal function. Worsening renal function increased risk for mortality (HR 2.2, 95% CI 1.17–4.27, p = .015) at a median follow‐up of 691 days. Those with improved/stable function with baseline GFR < 60 ml/min had comparable mortality risk to those with baseline GFR ≥ 60 ml/min (18% vs. 16.5%; HR 1.1, 95% CI 0.72–1.75, p = .62). Conclusion Among patients with baseline renal dysfunction, only 15% developed worsening renal function at 3–6 months after TAVR, which was associated with increased mortality. Predictors for worsening renal function include AKI and blood transfusions. Preventative measures peri‐procedurally and continued monitoring post‐discharge are warranted to improve outcomes.

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Changes in kidney function among patients undergoing transcatheter aortic valve replacement

Cited by 5 publications

References 35 publications

Evolution of chronic kidney disease after surgical aortic valve replacement or transcatheter aortic valve implantation

Evolution of chronic kidney disease after surgical aortic valve replacement or transcatheter aortic valve implantation

Association of frailty status with acute kidney injury and mortality after transcatheter aortic valve replacement: A systematic review and meta-analysis

Association between mid‐term worsening renal function and mortality after transcatheter aortic valve replacement in patients with chronic kidney disease

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