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Abstract: FR-PO034

Post-Trans-Catheter Aortic Valve Implantation AKI Stage 3 Requiring Renal Replacement Therapy and Mortality in Patients with Severe Aortic Stenosis and High Surgical Risk

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Duque Ballesteros, Juan Camilo, University of Miami, Miami, Florida, United States
  • Rivera-Maza, Manuel, University of Miami, Miami, Florida, United States
  • Contreras, Gabriel, University of Miami, Miami, Florida, United States
Background

Trans-catheter aortic valve implantation (TAVI) is an established treatment for severe symptomatic aortic stenosis (AS) in high surgical risk patients. However, post TAVI complications affect outcomes. Acute kidney injury (AKI) stage 3 requiring renal replacement therapy (RRT) after TAVI has been associated with high hospital mortality. Efforts to understand the factors that contribute to increase morbidity and mortality in patient undergoing TAVI are needed in order to decrease their morbidity and mortality.

Methods

The data of patients who underwent TAVI between 2012 and 2014 from the nationwide inpatient sample database was analyzed in this investigation. ICD-9-CM codes were used to identify hospital admissions for TAVI (procedure codes: 35.05 and 35.06) and new AKI stage 3 requiring RRT post-TAVI (diagnostic codes 584.5 to 584.9 plus procedure code 39.95). The primary outcome was AKI stage 3 requiring RRT post-TAVI. Stata/IC 14.2 was used to identify predictors of the primary outcome using multivariable regression analysis.

Results

An estimated total of 41,050 patients underwent TAVI during the pre-specified study period. Patient mean age was 81.1 years, 47.7 were women and 81% were white. 685 (1.7%) patients developed AKI stage 3 requiring RRT after TAVI. Hospital mortality was 30.7% in this subgroup. Multivariable regression analysis identified trans-apical approach (OR [95%CI], 1.67 [1.13-2.46]), preexisting chronic kidney disease (CKD) (OR [95%CI], 1.84[1.30-2.61]), non-elective TAVI (OR [95%CI], 2.24[1.58-3.18]), heart failure (OR [95% CI], 2.48 [1.58-3.90]], and procedural or post-procedural mechanical circulatory support (MCS) use (OR [95%CI], 3.39[1.77-6.50]) as predictors for AKI stage 3 requiring RRT.

Conclusion

Patients complicating with AKI stage 3 requiring RRT after TAVI have a high hospital mortality. Preexisting CKD, trans-apical approach, non-elective TAVI, development of heart failure and the need for MCS were significantly associated with AKI stage 3 after TAVI.