Patients who develop acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) show an increased mortality rate at one year post-procedure, according to late-breaking trial results presented at Cardiovascular Research Technologies (CRT) 2020 in National Harbor, Maryland.
Howard M. Julien, MD, MPH, of the Perelman School of Medicine, University of Pennsylvania, and colleagues performed this study using data from the Society of Thoracic Surgeons/American College of Cardiology National Cardiovascular Data Registry Transcatheter Valve Therapy registry. Data from January 2016 through June 2018 were used to create a predictive model in 107,814 patients, and this was linked to Medicare data to evaluate longitudinal outcomes.
The mean age of the overall population was 80.4 years. About 54% were men; 94% were Caucasian. Balloon-expandable valves were used in 71% of patients, and self-expanding valves were used in 28%.
The analysis showed that more than 10% of patients developed some degree of AKI after the procedure but that the incidence has decreased as TAVR has become more common. There were multiple predictors of AKI, including conversion to open heart surgery, baseline anemia, diabetes, cardiogenic shock and contrast volume used.
Authors also showed that any AKI was significantly associated with higher mortality and that stage 3 AKI had the highest impact on 1-year mortality (HR 9.13, 95% CI 7.8-10.5, P<0.001)
The authors concluded that patients who developed stage 3 AKI had 7 times higher adjusted 1-year mortality than those patients who did not develop AKI. Julien added that knowledge of factors associated with the development of AKI may help identify patients at risk of the most severe form of AKI and may prompt prevention strategies focused on these characteristics.
The research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry and the Society of Thoracic Surgeons National Database.