The risk of acute kidney injury following transapical versus transfemoral transcatheter aortic valve replacement: a systematic review and meta-analysis

Abstract

BackgroundThe aim of this systematic review is to examine the literature for the risk of acute kidney injury (AKI) in patients who underwent transcatheter aortic valve replacement (TAVR) based on transapical (TA) versus transfemoral (TF) approaches.MethodsA literature search was conducted utilizing Embase, Medline, Cochrane Database of Systematic Reviews and ClinicalTrials.gov from inception through December 2015. Studies that reported relative risk, odds ratio or hazard ratio comparing the AKI risk in patients who underwent TA-TAVR versus TF-TAVR were included. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random effect, generic inverse variance method.ResultsSeventeen cohort studies with 5085 patients were enrolled in the analysis to assess the risk of AKI in patients undergoing TA-TAVR versus TF-TAVR. The pooled RR of AKI in patients who underwent TA-TAVR was 2.26 (95% CI 1.79–2.86) when compared with TF-TAVR. When meta-analysis was confined to the studies with adjusted analysis for confounders evaluating the risk of AKI following TAVR, the pooled RR of TA-TAVR was 2.89 (95% CI 2.12–3.94). The risk for moderate to severe AKI [RR 1.02 (95% CI 0.57–1.80)] in patients who underwent TA-TAVR compared with TF-TAVR was not significantly higher.ConclusionsOur meta-analysis demonstrates an association between TA-TAVR and a higher risk of AKI. Future studies are required to assess the risks of moderate to severe AKI and mortality following TA-TAVR versus TF-TAVR.

Persistent acute kidney injury following transcatheter aortic valve replacement

“…Diabetes mellitus, prior PCI, use of IABP, and need for blood transfusion were independently associated pAKI risk factors. While the transapical approach has been shown to increase TAVR‐related AKI when compared with the transfemoral approach, it has not been correlated with severe or long‐term renal dysfunction . We did not find any association between the different TAVR approaches with pAKI or its outcomes.…”

“…Previous studies, including a very recent study by Aalaei‐Andabili et al, have identified important predictive factors for AKI after TAVR, including pre‐existing chronic kidney disease, diabetes mellitus, use of the transapical approach, need for circulatory support, peripheral artery disease, prior coronary artery bypass grafting, and periprocedural blood transfusion, suggesting close surveillance for AKI especially within 7 days after TAVR in these high‐risk populations . In the present study, we investigated potential risk factors for pAKI after TAVR.…”

Admission calcium levels and risk of acute kidney injury in hospitalised patients

“…1,2,4 Previous studies have attempted to identify novel biomarkers of AKI to allow earlier intervention and develop more effective pharmacological treatments and strategies. 1,3,[5][6][7][8][9] However, these have been mostly unsuccessful. 7,10 Hence, identifying high-risk patients for developing AKI is critical in order to prevent AKI events.…”

Changes in kidney function among patients undergoing transcatheter aortic valve replacement

“…Transcatheter aortic valve replacement (TAVR) has globally expanded in the past decade and now is acknowledged as a standard approach for patients who have severe aortic stenosis (AS) deemed inoperable with high surgical risk for open-heart aortic valve replacement surgery (1)(2)(3)(4)(5)(6). In addition, the recently published studies also suggest that patient selection for TAVR is evolving toward treating lower surgical risk patients (7)(8)(9).…”