Preventing AKI after TAVR may help lessen the impact of chronic kidney disease
Acute kidney injury (AKI) is seen in more than 17% of transcatheter aortic valve replacement (TAVR) patients, nearly doubling their risk of one-year mortality, according to new findings published in the Journal of the American Heart Association.[1] The study’s authors also hoped to learn about AKI’s relationship to chronic kidney disease (CKD), noting that both are associated with poor TAVR outcomes.
“TAVR has become the standard of care for patients with severe symptomatic aortic stenosis who are at intermediate and high risk for surgery,” wrote first author Gabriele Crimi, MD, an interventional cardiologist with Ospedale Policlinico San Martino in Italy, and colleagues. “As TAVR is also becoming an attractive therapeutic option for patients at lower surgical risk, prompt recognition and management of intra‐ and periprocedural complications become pivotal.”
Crimi et al. examined data from more than 2,600 TAVR patients treated at one of five high-volume facilities in Italy. The mean patient age was 82 years old, and 53.9% of patients were female. Patients were excluded if they died within 24 hours of the procedure.
Overall, AKI was seen in 17.3% of TAVR patients. While 84.2% of those patients had stage 1 AKI, 9.1% had stage 2 AKI and 13.9% had stage 3 AKI. All-cause mortality was “significantly higher” among AKI patients than patients without AKI after 30 days (5.1% vs. 2.5%) and after one year (15.9% vs. 8%).
Also, bleeding complications were seen in 23% of TAVR patients and linked to much lower survival rates after 30 days and one year. CKD, meanwhile, was seen in 35.1% of TAVR patients. After one year, 19.1% of patients with CKD had died and 8.4% of patients without CKD had died. Higher CKD stages were associated with a higher risk of death than lower CKD stages. The team also explored each TAVR patient’s eGFR value, concluding that patients with stage 4 or stage 5 CKD had a much higher risk of developing AKI.
Stage 4 or 5 CKD, AKI and bleeding events were all associated with an increased risk of mortality after one year, the researchers observed. They also ran a series of analyses to determine if AKI is specifically responsible for any of the clinical impact associated with stage 4 CKD and stage 5 CKD. Reviewing their findings, the group concluded that, yes, AKI was partially responsible for the significant clinical impact of CKD. Preventing AKI, they theorized, would help reduce the effect of CKD on post-TAVR mortality by a sizable margin.
“AKI, a potentially preventable complication, mediates one fifth of the effect of baseline CKD, one of the strongest predictors of mortality after TAVR on all‐cause mortality after one‐year follow up,” Crimi and colleagues wrote. They added that “further studies are urgently needed to disentangle this complex scenario and to encourage a systematic effort to prevent AKI during TAVR, finally potentially leading to an improvement of patients’ one-year survival.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.