The association between renal recovery after acute kidney injury and long-term mortality after transcatheter aortic valve replacement

Abstract

BackgroundThis study aimed to examine the association between renal recovery status at hospital discharge after acute kidney injury (AKI) and long-term mortality following transcatheter aortic valve replacement (TAVR).MethodsWe screened all adult patients who survived to hospital discharge after TAVR for aortic stenosis at a quaternary referral medical center from January 1, 2008, through June 30, 2014. An AKI was defined as an increase in serum creatinine level of 0.3 mg/dL or a relative increase of 50% from baseline. Renal outcome at the time of discharge was evaluated by comparing the discharge serum creatinine level to the baseline level. Complete renal recovery was defined as no AKI at discharge, whereas partial renal recovery was defined as AKI without a need for renal replacement therapy at discharge. No renal recovery was defined as a need for renal replacement therapy at discharge.ResultsThe study included 374 patients. Ninty-eight (26%) patients developed AKI during hospitalization: 55 (56%) had complete recovery; 39 (40%), partial recovery; and 4 (4%), no recovery. AKI development was significantly associated with increased risk of 2-year mortality (hazard ratio [HR], 2.20 [95% CI, 1.37–3.49]). For patients with AKI, the 2-year mortality rate for complete recovery was 34%; for partial recovery, 43%; and for no recovery, 75%; compared with 20% for patients without AKI (P < .001). In adjusted analysis, complete recovery (HR, 1.87 [95% CI, 1.03–3.23]); partial recovery (HR, 2.65 [95% CI, 1.40–4.71]) and no recovery (HR, 10.95 [95% CI, 2.59–31.49]) after AKI vs no AKI were significantly associated with increased risk of 2-year mortality.ConclusionThe mortality rate increased for all patients with AKI undergoing TAVR. A reverse correlation existed for progressively higher risk of death and the extent of AKI recovery.

Acute Kidney Injury in Patients Undergoing Cardiac Transplantation: A Meta-Analysis

“…A larger cohort is currently under investigation. Lastly, AKI is a known independent risk factor for the development of CKD [60][61][62] and one of the important adverse effects of calcineurin inhibitors among cardiac transplant patients is the development of CKD leading to ESKD. Future studies are required if optimizing/modifying the immunosuppressive regimen among cardiac transplant patients with AKI can help prevent CKD and delay CKD progression.…”

Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…65 This mortality rate appears to be further amplified by the presence of atrial fibrillation, with 1-year mortality rates as high as 71%. 66 The development of acute kidney injury in the peri-procedural TAVR setting is also associated with worse outcomes, 74,75 especially if post-TAVR HD is required. 76 Thus, while clear evidence exists that TAVR outcomes have been improving as the technique has become more established (rates of TAVR are increasing rapidly and have surpassed surgical AVR in some jurisdictions 77 ), there is a persistent signal of adverse outcomes in patients with ESKD.…”

Assessment of Kidney Function After Transcatheter Aortic Valve Replacement

“…Two-year follow-up in patients after TAVR demonstrated 80% survival in patients who did not develop AKI, compared with 66% in patients with AKI who had complete recovery and 25% when there was no recovery in kidney function. 12 …”

“…Two-year follow-up in patients after TAVR demonstrated 80% survival in patients who did not develop AKI, compared with 66% in patients with AKI who had complete recovery and 25% when there was no recovery in kidney function. 12 In contrast to the harmful consequences of AKI, some studies have noted a partial improvement in kidney functions after TAVR and suggested there was a positive effect on survival in these patients. They referred to this as acute kidney recovery (AKR).…”