The association between renal recovery after acute kidney injury and long-term mortality after transcatheter aortic valve replacement.

Charat Thongprayoon,Wonngarm Kittanamongkolchai,Narat Srivali,Wisit Cheungpasitporn,Ankit Sakhuja,Kevin L Greason,Kianoush B Kashani

doi:10.1371/journal.pone.0183350

Charat Thongprayoon, Wonngarm Kittanamongkolchai + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0183350

Copy DOI

Journal: PloS one	Publication Date: Aug 17, 2017
Citations: 13	License type: CC BY 4.0

Affiliation: Mayo Clinic

Abstract

BackgroundThis study aimed to examine the association between renal recovery status at hospital discharge after acute kidney injury (AKI) and long-term mortality following transcatheter aortic valve replacement (TAVR).MethodsWe screened all adult patients who survived to hospital discharge after TAVR for aortic stenosis at a quaternary referral medical center from January 1, 2008, through June 30, 2014. An AKI was defined as an increase in serum creatinine level of 0.3 mg/dL or a relative increase of 50% from baseline. Renal outcome at the time of discharge was evaluated by comparing the discharge serum creatinine level to the baseline level. Complete renal recovery was defined as no AKI at discharge, whereas partial renal recovery was defined as AKI without a need for renal replacement therapy at discharge. No renal recovery was defined as a need for renal replacement therapy at discharge.ResultsThe study included 374 patients. Ninty-eight (26%) patients developed AKI during hospitalization: 55 (56%) had complete recovery; 39 (40%), partial recovery; and 4 (4%), no recovery. AKI development was significantly associated with increased risk of 2-year mortality (hazard ratio [HR], 2.20 [95% CI, 1.37–3.49]). For patients with AKI, the 2-year mortality rate for complete recovery was 34%; for partial recovery, 43%; and for no recovery, 75%; compared with 20% for patients without AKI (P < .001). In adjusted analysis, complete recovery (HR, 1.87 [95% CI, 1.03–3.23]); partial recovery (HR, 2.65 [95% CI, 1.40–4.71]) and no recovery (HR, 10.95 [95% CI, 2.59–31.49]) after AKI vs no AKI were significantly associated with increased risk of 2-year mortality.ConclusionThe mortality rate increased for all patients with AKI undergoing TAVR. A reverse correlation existed for progressively higher risk of death and the extent of AKI recovery.

Highlights

Transcatheter aortic valve replacement (TAVR) is a revolutionary, relatively new catheterbased technique for treating patients with severe aortic stenosis who are at high risk for a surgical aortic valve replacement [1]
This study aimed to examine the association between renal recovery status at hospital discharge after acute kidney injury (AKI) and long-term mortality following transcatheter aortic valve replacement (TAVR)
Complete renal recovery was defined as no Acute kidney injury (AKI) at discharge, whereas partial renal recovery was defined as AKI without a need for renal replacement therapy at discharge

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) is a revolutionary, relatively new catheterbased technique for treating patients with severe aortic stenosis who are at high risk for a surgical aortic valve replacement [1]. Recent studies have suggested the potential use of TAVR for patients at intermediate [2,3] and low risk [4], as well as for a subset of patients whose aortic stenosis was more technically challenging to repair surgically [5,6]. Acute kidney injury (AKI) after TAVR is common (reported for up to 57% of patients) [7,11,12] and is independently associated with a higher risk of mortality [12,13]. We aimed to examine the association between renal recovery status at hospital discharge after AKI and long-term mortality following TAVR. This study aimed to examine the association between renal recovery status at hospital discharge after acute kidney injury (AKI) and long-term mortality following transcatheter aortic valve replacement (TAVR)

Objectives

Methods

Results

Conclusion