Author + information
- Karim M. Al-Azizi,
- Ahmed M. Alabbady,
- Joyce A. Burnside,
- Joseph J. Stella,
- Sandy M. Green,
- Thomas D. Scott,
- James C. Blankenship and
- Kimberly A. Skelding
Risk scores identify patients at risk for acute kidney injury (AKI) following coronary procedures. Patients with kidney disease have been shown to have worse outcomes following Transcatheter Aortic Valve Replacement (TAVR).
Identifying patients at risk to provide benefit and avoid harm is paramount. We aim TO validate the Contrast Induced Nephropathy (CIN) risk score in patients undergoing TAVR.
An institutional review board approved retrospective cohort study in a tertiary care center in rural Pennsylvania utilizing a balloon expandable TAVR device, identified 164 patients with complete renal function data not on dialysis. Creatinine was evaluated before and after each TAVR. Contrast volume, type, patient comorbidities and demographics were collected. The Kidney disease improving global outcomes (KDIGO) definition was used to identify AKI. Descriptive statistics include frequencies for categorical data and means or medians for continuous data. Comparisons were made using Chi-square test or fishers exact test and the t-test or median test. Odds ratios were calculated for the logistic regression model. P value less than 0.05 was significant. We utilized the William Beaumont Hospital CIN score for risk stratification.
Baseline demographics were not significantly different between the 2 groups (AKI vs non AKI), with a mean age of 82.5, and 54.3% males. 25 patients developed AKI. There was a significant difference in CIN risk score between both groups (4.3 AKI vs 3.4 non AKI, p=0.0174). On multivariate analysis the only predictor of AKI with TAVR was the William Beaumont Hospital CIN score (Odds ratio 1.39 (1.05-1.83) p=0.0201, with a c-statistic=0.660. Having a CIN score of >4 was predictive of AKI (OR 4.3 (1.53-12.10) p=0.006, c=statistic 0.659. Contrast volume used was not significantly different between both groups (145.9ml vs 139.5ml, p=0.7338). No comorbidities were statistically significant between patients with or without AKI post TAVR.
CIN risk scoring appears to similarly identify patients at risk for AKI whether they are undergoing a coronary procedure or a TAVR procedure. There were no other variables more predictive of AKI in this study.