Acute kidney injury and acute kidney recovery following Transcatheter Aortic Valve Replacement

• Main Authors: Marilou Peillex, Benjamin Marchandot, Kensuke Matsushita, Eric Prinz, Sebastien Hess, Antje Reydel, Marion Kibler, Adrien Carmona, Antonin Trimaille, Joe Heger, Hélène Petit-Eisenmann, Annie Trinh, Laurence Jesel, Patrick Ohlmann, Olivier Morel
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2021-01-01
• Series: PLoS ONE
• Online Access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354447/?tool=EBI

<h4>Background</h4> Acute kidney injury (AKI) is associated with a dismal prognosis in Transcatheter Aortic Valve replacement (TAVR). Acute kidney recovery (AKR), a phenomenon reverse to AKI has recently been associated with better outcomes. <h4>Methods</h4> Between November 2012 to May 2018, we explored consecutive patients referred to our Heart Valve Center for TAVR. AKI was defined according to the VARC-2 definition. Mirroring the VARC-2 definition of AKI, AKR was defined as a decrease in serum creatinine (≥50%) or ≥25% improvement in GFR up to 72 hours after TAVR. <h4>Results</h4> AKI and AKR were respectively observed in 8.3 and 15.7% of the 574 patients included. AKI and AKR patients were associated to more advanced kidney disease at baseline. At a median follow-up of 608 days (range 355–893), AKI and AKR patients experienced an increased cardiovascular mortality compared to unchanged renal function patients (14.6% and 17.8% respectively, vs. 8.1%, CI 95%, p<0.022). Chronic kidney disease, (HR: 3.9; 95% CI 1.7–9.2; p < 0.001) was the strongest independent factor associated with AKI similarly to baseline creatinine level (HR: 1; 95% CI 1 to 1.1 p < 0.001) for AKR. 72-hours post procedural AKR (HR: 2.26; 95% CI 1.14 to 4.88; p = 0.021) was the strongest independent predictor of CV mortality. <h4>Conclusions</h4> Both AKR and AKI negatively impact long term clinical outcomes of patients undergoing TAVR.