Acute kidney injury after transcatheter aortic valve implantation: Impact of contrast agents, predictive factors, and prognostic importance in 203 patients with long-term follow-up

• Published in: Journal of cardiology Vol. 66; no. 6; pp. 514 - 519
• Main Authors: Chatani, Kenichi, MD, Abdel-Wahab, Mohamed, MD, Wübken-Kleinfeld, Nora, MD, Gordian, Ken, MD, Pötzing, Kathrin, MD, Mostafa, Ahmad E., MD, Kraatz, Ernst-Günter, MD, Richardt, Doreen, MD, El-Mawardy, Mohamed, MD, Richardt, Gert, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.12.2015
• Subjects: Acute kidney injury; Acute Kidney Injury - blood; Acute Kidney Injury - etiology; Acute Kidney Injury - mortality; Aged; Aged, 80 and over; Aortic Valve Stenosis - blood; Aortic Valve Stenosis - surgery; Cardiac Catheterization - adverse effects; Cardiovascular; Contrast Media - adverse effects; Contrast Media - chemistry; Contrast medium; Creatinine - blood; Female; Follow-Up Studies; Humans; Long-term clinical outcome; Male; Odds Ratio; Osmolar Concentration; Prognosis; Risk Factors; Time Factors; Transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter aortic valve implantation; Long-term clinical outcome; Contrast medium; Acute kidney injury
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2015.02.007

Abstract Background Acute kidney injury (AKI) frequently occurs following transcatheter aortic valve implantation (TAVI) and has been related to a worse outcome. We investigated the importance of contrast medium composition, either iso-osmolar (IOCM) or low-osmolar (LOCM) and assessed predictors for AKI after TAVI. Methods and results We assessed AKI in 203 TAVI patients treated mainly with trans-femoral implantation and analgosedation. A total of 100 patients received IOCM and 103 LOCM. AKI was defined according to the Valve Academic Research Consortium. Following TAVI, 39 patients (19.2%) developed AKI; 17.0% of the IOCM and 21.4% of the LOCM group ( p = 0.43). The only independent predictor for AKI was baseline serum creatinine [odds ratio (OR) 0.26, 95% confidence interval (CI) 0.01–0.64, p = 0.002]. Patients with advanced AKI (stages 2 and 3) post-TAVI had significantly higher mortality at 2 years (log rank p < 0.001), whereas patients with AKI stage 1 had a similar long-term outcome to non-AKI patients. Conclusions Following TAVI, we observed no difference in the occurrence of AKI between IOCM and LOCM. Baseline creatinine was the only independent predictor of AKI, and patients who developed advanced AKI had significantly higher mortality at 2 years.