Author + information
- Karim Al-Azizi,
- Ahmed M. Alabbady,
- Joyce A. Burnside,
- Joseph J. Stella,
- Sandy M. Green,
- Thomas D. Scott,
- James C. Blankenship and
- Kimberly A. Skelding
Patients with chronic kidney disease have worse outcomes following TAVR (Transcatheter Aortic Valve Replacement). They are older, have more comorbidities and are exposed to significant volumes of contrast and risk for peri-procedural thromboembolic events. Identifying patients we can provide the highest benefit and incur the lowest amount of harm is increasingly important.
We aim to determine if TAVR has a higher risk for AKI compared to coronary procedures.
In this institutional review board, approved, retrospective cohort study in a high volume tertiary care center in rural Pennsylvania utilizing a balloon expandable TAVR, we identified 63 patients with complete renal function data not on dialysis undergoing cardiac catheterization and TAVR. Creatinine (Cr) was evaluated before and after both procedures. Contrast volume, type and patient demographics were collected. The KDIGO (Kidney disease improving global outcomes) definition was used to identify acute kidney injury (AKI). We used means and medians for comparisons with a P value less than 0.05 as significant.
Univariate variables associated with AKI were compared. No comorbidities were statistically significant between patients with or without AKI in each group, except coronary artery disease, which was higher in the non AKI group within the TAVR group. Contrast use was significantly different between TAVR and coronary procedures (108.5ml vs 142.7ml, p=0.0044). 12 patients developed AKI in each group (19.1% post catheterization and 18.5% in the TAVR, p= 1.00). There was no difference in CIN risk score between both groups (4.0 vs 3.9, p=0.7362). 4 patients had AKI with both procedures. Risk of AKI with TAVR after an AKI with cardiac catheterization had an Odds Ratio of 2.69 (0.65-11.09) 95% confidence interval, p=0.1181.
Risk of nephropathy with TAVR was similar to cardiac catheterization in this study. Despite the difference of contrast volume used between both procedures, rate of AKI remained the same between both groups. Larger studies are needed to better understand such a relationship and identify other variables that may contribute to AKI post TAVR.