Renal Function–Based Contrast Threshold Predicts Kidney Injury in Transcatheter Aortic Valve Replacement

Abstract

<h2>Abstract</h2><h3>Background</h3> Acute kidney injury (AKI) after contrast-guided interventions is associated with adverse outcomes, but the role of contrast in the context of renal function is less well described for patients undergoing transcatheter aortic valve replacement (TAVR). <h3>Methods</h3> Patients from the Michigan TAVR registry between January 2016 and December 2019 were included. AKI was defined using Valve Academic Research Consortium 2 definitions. An integer cut point for the ratio of contrast volume (CV) to renal function (estimated glomerular filtration rate [eGFR]) as a predictor of AKI was calculated. <h3>Results</h3> Of 7112 cases, AKI occurred in 629 (8.8%) patients. Unadjusted mortality was higher among patients with AKI (32.5% vs 9.0%, <i>P</i> ​< ​.0001). AKI remained significantly associated with the risk of mortality after multivariable adjustment (hazard ratio=4.50, <i>P</i> ​< ​.001). Procedural characteristics associated with AKI included CV/eGFR >2 (adjusted odds ratio [aOR] = 1.36, <i>P</i> = .003, 95% CI=1.10-1.67), CV/eGFR >3 (aOR = 1.38, <i>P</i> ​= ​.009, 95% CI=1.09-1.77), and use of general anesthesia (aOR = 1.67, <i>P</i> ​< ​.0001, 95% CI=1.38-2.03). <h3>Conclusions</h3> CV in the context of renal function administrated during TAVR is a robust tool to predict AKI. AKI after TAVR is associated with an increased risk of mortality. Incorporation of thresholds of >2× and > 3× eGFR into procedural planning should be considered as a quality initiative.