A1 Refereed original research article in a scientific journal
Acute Kidney Injury Following Aortic Valve Replacement in Patients Without Chronic Kidney Disease
Authors: Noriaki Moriyama, Teemu Laakso, Peter Raivio, Sebastian Dahlbacka, Eeva-Maija Kinnunen, Tatu Juvonen, Antti Valtola, Annastiina Husso, Maina P. Jalava, Tuomas Ahvenvaara, Tuomas Tauriainen, Jarkko Piuhola, Asta Lahtinen, Matti Niemelä, Timo Mäkikallio, Marko Virtanen, Pasi Maaranen, Markku Eskola, Mikko Savontaus, Juhani Airaksinen, Fausto Biancari, Mika Laine
Publisher: Elsevier
Publication year: 2021
Journal: Canadian Journal of Cardiology
Journal name in source: The Canadian journal of cardiology
Journal acronym: Can J Cardiol
ISSN: 0828-282X
eISSN: 1916-7075
DOI: https://doi.org/10.1016/j.cjca.2020.03.015
Self-archived copy’s web address: https://helda.helsinki.fi/bitstream/handle/10138/328204/1_s2.0_S0828282X20302701_main.pdf?sequence=1
BackgroundThe data on acute kidney injury (AKI) in patients without chronic kidney disease (CKD) after transcatheter aortic valve replacement (TAVR) are limited. The study sought to compare the incidence of AKI and its impact on 5-year mortality after TAVR and surgical aortic valve replacement (SAVR) in patients without CKD.MethodsThis registry included data from 6463 consecutive patients who underwent TAVR or SAVR. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria. For sensitivity analysis, propensity-score matching between TAVR and SAVR was performed.ResultsThe study included 4555 consecutive patients (TAVR, n = 1215 and SAVR, n = 3340) without CKD. Propensity-score matching identified 542 pairs. Patients who underwent TAVR had a significantly lower incidence of AKI in comparison to those who underwent SAVR (unmatched 4.7% vs 16.4%, P < 0.001, multivariable analysis: odds ratio, 0.29, 95% confidence interval [CI], 0.20-0.41; matched 5.9% vs 19.0%, P < 0.001). Patients with AKI had significantly increased 5-year mortality compared with those without AKI (unmatched 36.0% vs 19.1%, log-rank P < 0.001; matched 36.3% vs 24.0%, log-rank P < 0.001). The adjusted hazard ratios for 5-year mortality were 1.58 (95% CI, 1.20-2.08) for AKI grade 1, 3.27 (95% CI, 2.09-5.06) for grade 2, and 4.82 (95% CI, 2.93-8.04) for grade 3.ConclusionsTAVR in patients without CKD was associated with a significantly less frequent incidence of AKI compared with SAVR. AKI significantly increased the risk of 5-year mortality after either TAVR or SAVR, and increasing severity of AKI was incrementally associated with 5-year mortality.
