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

Abstract

Background/Aim: Transcatheter aortic valve implantation (TAVI) is a method which is increasingly applied in severe aortic stenosis treatment. The development of contrast-induced nephropathy (CIN) after TAVI increases morbidity and mortality rates. Within the scope of this study, the importance of the contrast medium volume to glomerular filtration rate (CV/GFR) ratio in determining the development of CIN and the amount of CV that could be applied was evaluated. Methods: Seventy-two patients (aged 78.6 ± 11.6 years; 38 females) who underwent aortic valve replacement with the TAVI method between June 2013 and August 2014 were included in the study. CIN was defined as an absolute increase in serum creatinine of >0.5 mg/dl or a relative increase of >25% within 48-72 h after TAVI. CIN+ and CIN- patients were classified into two groups. The χ² test, t test, Mann-Whitney U test, ROC analysis, and univariate and multivariate regression analyses were applied for statistical analyses. Results: CIN was detected in 16 patients (22%) in our study. Baseline creatinine, baseline GFR, the Mehran risk score, CV, and the CV/GFR ratio were determined as the predictive factors of CIN development. A CV/GFR ratio of 3.9 was specified to predict CIN development with 71% sensitivity and 80% specificity. Conclusion: After TAVI, CIN may develop due to various reasons. In patients to whom TAVI was applied, the CV/GFR ratio may be a guideline helping to prevent the development of renal pathologies. The amount of contrast medium that can be given to a patient can be calculated in terms of baseline GFR.

A simplified acute kidney injury predictor following transcatheter aortic valve implantation: the ACEF score

“…The ACEF score has previously been studied in patients undergoing TAVI, but most of these studies focused on predicting mortality from the ACEF score [21,22]. In addition, previously, some studies showed the relationship between increasing age and AKI development in TAVI patients [23], nevertheless, some studies revealed that there was no statistically significant relationship between age and AKI development [9,10,24]. Although low LVEF has previously been reported to be an important predictor of AKI development [23,24], Pyxaras et al indicated that low LVEF is not associated with the development of AKI after TAVI [25].…”

“…Several studies investigated the utility of baseline, procedural characteristics or risk scores in predicting AKI following TAVI. These studies revealed that the development of AKI was closely associated with the patients' poor clinical outcome [7][8][9][10].…”

Magna Graecia transcatheter aortic valve implantation registry: data on contrast medium osmolality and postprocedural acute kidney injury

“…The amount of CM was recorded during all TAVI procedures. According to the previous investigations, the CM volume x SCr/body weight, CM volume/CrCl and CM volume/eGFR ratios were used to evaluate the degree of CM dose in individual patients [3] , [4] , [5] .…”

Importance of Femoral Access Method in Predicting the Development of Contrast Induced Nephropathy after Transfemoral Transcatheter Aortic Valve Implantation

“…Especially during the placement of VCDs into the femoral artery and closure, extra CM use is required. Many literature studies have examined CIN and renal failure development subsequent to TAVI (16,17,32) . However, a study that examines CIN development by vascular closure techniques is not available.…”