Predictors and outcome of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis

Abstract

The reason for the occurrence of AKI was multifactorial, including baseline characteristics, procedure-related and post-TAVI factors. It appeared that even stage 1 AKI exerted detrimental effects on survival within one year, and AKI was also independently linked to mortality beyond three years.

Predicting Acute Kidney Injury following Transcatheter Aortic Valve Replacement

“…Second, the incidence of AKI post-TAVR (24-38%) in our study is in line with previously reported frequencies [5,6]. Third, although our results did not demonstrate a correlation between angiogram AKI and TAVR AKI, they did identify baseline renal function and contrast volume as independent predictors of post-TAVR AKI.…”

“…Although physician experience and technology are improving, procedural complications remain a common issue affecting patient outcomes. Specifically, acute kidney injury (AKI) occurs in as many as 8.3-58% of patients, and has been shown to be associated with increased 30-day and three-year post-TAVR mortality rates [5,6]. A recent systematic review confirmed this relationship by demonstrating that developing an AKI, results in a 2-6 fold increase in post-TAVR mortality [5].…”

“…Existing literature has documented a variety of patient characteristics that place individuals at increased risk for post-TAVR AKI. Diabetes mellitus, hypertension, chronic kidney disease and both pre-and post-procedural anemia have all been identified as independent predictors for the development of post-procedure AKI [6][7][8][9]. Beyond individual patient factors, several intraoperative (general anesthesia, trans-apical approach), and postoperative (transfused >3 units of packed red blood cells, hemoglobin drop, contrast media volume, major bleeding) factors have been shown to increase the risk of AKI post-TAVR [7,[10][11][12]; however, these results have not been consistently replicated.…”

The obesity paradox in patients undergoing transcatheter aortic valve implantation: is there any effect of body mass index on survival?

“…A recent study proved that bleeding complications and blood transfusion were predictors of AKI [27]. In addition, the detrimental effect of red blood cell transfusion on AKI and long-term survival was associated with an increased number of transfusions [28].…”

Mortality after transcatheter versus surgical aortic valve replacement: an updated meta-analysis of randomised trials

“…Meta-regression plot (meta-regression line with 95% confidence interval curves) of the principal analysis (as-treated population) of the primary end point: risk differences in 1-year all-cause mortality (between transcatheter aortic valve implantation and surgical aortic valve replacement) on Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score et al [16] demonstrated, in their meta-analysis of 35 studies with a total of 13,256 patients undergoing TAVI, that the aggravating severity of AKI was progressively associated with short-term all-cause mortality (univariate OR of 30-day mortality for stage 1, 3.41; for stage 2, 4.0; for stage 3, 11.02; univariate OR of 1-year mortality for stage 1, 1.95; stage 2, 2.82; stage 3, 7.34). Even after controlling confounders, AKI was independently associated with a higher risk of both 30-day [multivariate hazard ratio (HR) 2.12; 95% CI 1.59-2.83] and ≥3-year all-cause mortality (multivariate HR 1.37; 95% CI 1.27-1.48) [16]. Faster and better recovery of left ventricular function [17] and less frequent pulmonary complications [18] after TAVI than after SAVR may also explain the present results.…”