Bedside Renal Doppler Ultrasonography and Acute Kidney Injury after TAVR.

Sophie Bayer,Laurence Jesel,Adrien Carmona,Eric Prinz,Benjamin Marchandot,Antonin Trimaille,Marilou Peillex,Hélène Petit-Eisenmann,Joe Heger,Olivier Morel,Kensuke Matsushita,Patrick Ohlmann

doi:10.3390/jcm9040905

Abstract

Acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR) is associated with a dismal prognosis. Elevated renal resistive index (RRI), through renal Doppler ultrasound (RDU) evaluation, has been associated with AKI development and increased systemic arterial stiffness. Our pilot study aimed to investigate the performance of Doppler based RRI to predict AKI and outcomes in TAVR patients. From May 2018 to May 2019, 100 patients with severe aortic stenosis were prospectively enrolled for TAVR and concomitant RDU evaluation at our institution (Nouvel Hôpital Civil, Strasbourg University, France). AKI by serum Creatinine (sCr-AKI) was defined according to the VARC-2 definition and AKI by serum Cystatin C (sCyC-AKI) was defined as an sCyC increase of greater than 15% with baseline value. Concomitant RRI measurements as well as renal and systemic hemodynamic parameters were recorded before, one day, and three days after TAVR. It was found that 10% of patients presented with AKIsCr and AKIsCyC. The whole cohort showed higher baseline RRI values (0.76 ± 0.7) compared to normal known and accepted values. AKIsCyC had significant higher post-procedural RRI one day (Day 1) after TAVR (0.83 ± 0.1 vs. 0.77 ± 0.6, CI 95%, p = 0.005). AUC for AKIsCyC was 0.766 and a RRI cut-off value of ≥ 0.795 had the most optimal sensitivity/specificity (80/62%) combination. By univariate Cox analysis, Mehran Risk Score, higher baseline right atrial pressure at baseline >0.8 RRI values one day after TAVR (HR 6.5 (95% CI 1.3–32.9; p = 0.021) but not RRI at baseline were significant predictors of AKIsCyC. Importantly, no significant impact of baseline biological parameters, renal or systemic parameters could be demonstrated. Doppler-based RRI can be helpful for the non-invasive assessment of AKI development after TAVR.

Highlights

Acute kidney injury (AKI) is a common complication following transcatheter aortic valve replacement (TAVR) and remains associated with a dismal prognosis
Of the 100 TAVR patients recruited, AKI was documented respectively for 10%; 10%, 16%, and 4% of the global cohort according to the Acute kidney injury by serum Creatinine (AKIsCr), AKIsCyC, AKIsCr, OR sCyC and AKIsCr AND sCyC definitions respectively (Table 4)
Regarding AKI as determined by serum creatinine (AKIsCr), stage 1 AKI according to the AKIN system occurred in eight patients, stage 2 in two patients, and none in stage 3

Summary

Introduction

Acute kidney injury (AKI) is a common complication following transcatheter aortic valve replacement (TAVR) and remains associated with a dismal prognosis. Based on the current Valve Academic Research Consortium (VARC)-2 definition [1], the reported incidence of post TAVR AKI is 22.1% ± 11.2 [2]. Depicting the scope of AKI in the field of TAVR relies on a variety of factors from impaired baseline renal function, hemodynamic instability during pacing, and use of contrast medium, to post procedural complications such as bleeding. Given that TAVR is expected to be increasingly performed, screening high-risk patients for AKI is of paramount importance since easy, accessible, and preventive measures, such as optimal periprocedural hydration and careful contrast use, are available. The prediction of AKI after TAVR and AKI prevention are key approaches in current practice

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Conclusion