Predictive value of acute kidney injury for major adverse cardiovascular events following tricuspid annuloplasty: A comparison of three consensus criteria

• Published in: Journal of cardiology Vol. 72; no. 3; pp. 247 - 254
• Main Authors: Wu, Mei-Zhen, Chen, Yan, Au, Wing-Kok, Chan, Daniel, Sit, Ko-Yung, Ho, Kar-Lai, Ho, Lai-Ming, Lam, Yui-Ming, Lau, Chu-Pak, Chan, Tak-Mao, Tse, Hung-Fat, Yiu, Kai-Hang
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2018
• Subjects: Acute kidney injury; Outcome; Tricuspid annuloplasty; Tricuspid annuloplasty; Acute kidney injury; Outcome
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2018.01.018

•This study evaluated the occurrence rate and prognostic value of AKI after TA.•The occurrence rate of AKI was defined according to RIFLE, AKIN, and KDIGO.•AKI defined by three criteria affected over half of patients undergoing TA.•The presence of AKI by all three criteria was associated with adverse events.•AKIN and KDIGO were more useful than RIFLE to predict mortality beyond 30 days. Tricuspid annuloplasty (TA) is increasingly being performed, but the clinical outcome is unsatisfactory. Acute kidney injury (AKI) is a common complication following cardiac surgery and predicts outcome. Nonetheless the occurrence rate and prognostic value of AKI after TA are unclear. This study reviewed 339 consecutive patients (age 65±11 years; male 42%) who underwent TA. The incidence of AKI was defined according to risk/injury/failure/loss/end stage (RIFLE), acute kidney injury network (AKIN), and kidney disease improving global outcomes (KDIGO) criteria, respectively. Major adverse cardiovascular events (MACE) was defined as death, heart failure, stroke, and myocardial infarction (MI). The influence of AKI on MACE was evaluated as a short-term outcome and outcome beyond 30 days. The incidence of AKI, defined according to RIFLE, AKIN, and KDIGO was 57%, 52%, and 53%, respectively. MACE occurred in 94 cases (21 deaths, 63 heart failure requiring hospitalization, 7 stroke, and 3 MI). For short-term outcome, AKI defined by all three scoring systems was independently associated with MACE and death (p<0.01 for both), but not heart failure, stroke, or MI. For outcome beyond 30 days, AKI by all three criteria was associated with MACE and heart failure. Only AKI by AKIN and KDIGO, but not RIFLE, was independently associated with death. Our data suggest AKI affects over half of all patients who undergo TA, and has a major and long-lasting impact on survival, MACE, and heart failure. Use of AKIN and KDIGO is more useful than the RIFLE criteria when determining the prognostic value of AKI for mortality beyond 30 days.