Renal Function–Based Contrast Dosing Predicts Acute Kidney Injury Following Transcatheter Aortic Valve Implantation

Abstract

Although mechanisms of AKI following TAVI are multifactorial, the present study identified a relationship between CM dose increment and high prevalence of AKI. Therapeutic efforts not to exceed the threshold value may reduce the risk of AKI.

Clinical impact of acute kidney injury on short- and long-term outcomes after transcatheter aortic valve implantation with the CoreValve prosthesis

“…Nevertheless, several previous investigations have identified that a ratio of contrast media  serum creatinine/body weight over 2.7 is associated with an increased risk of AKI after TAVI; therefore, the contrast dose should be adjusted [16].…”

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

“…110 In coronary interventions, a contrast volume >100cc has been associated with AKI. 111 Only one study has demonstrated a linear relationship between the ratio of contrast to body size and subsequent AKI in TAVR 92 .…”

“…In previous studies, when patients that developed AKI were compared to those that didn't the 30-day and 1-year mortality was significantly higher in those with AKI. 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.…”

The Importance of Contrast Volume/Glomerular Filtration Rate Ratio in Contrast-Induced Nephropathy Patients after Transcatheter Aortic Valve Implantation

“…However, these variables do not differ among the groups in our study (tables 1, 2). With regard to surgery, factors that facilitate CIN development are: increase in the amount of contrast medium, hemodynamic irregularities, and hypotension [12,13,14,15,16,17,18,19,20,21]. During TAVI operation in particular, hypotensive periods may occur, thus increasing CIN probability.…”

“…Thus, factors that can lead to the development of CIN after interventional cardiovascular operations must be well known. It has been specified that the contrast medium volume (CV) used in invasive operations is the most important factor causing AKI [12,13]. The CV/glomerular filtration rate (GFR) ratio, a useful indicator of the development of nephropathy, depends on the amount of contrast medium administered after percutaneous coronary intervention (PCI) [14].…”