Acute kidney injury and Acute kidney recovery following TAVR: Conflicting results with regards to earlier studies

Abstract

Acute kidney injury (AKI) remains associated with a dismal prognosis in TAVR. Acute kidney recovery (AKR), a phenomenon reverse to AKI has recently been associated with better outcomes. 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. 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 as 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 ( Fig. 1 ). 72-hours post procedural AKR patients are a subgroup of patients at high risk of post TAVR cardiovascular complications