NDT Advance Access published online on February 11, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp036
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Risk of acute kidney injury in patients with severe aortic valve stenosis undergoing transcatheter valve replacement
1 Department of Nephrology/Hypertension 2 Department of Cardiology 3 Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
Correspondence and offprint requests to: Fabienne Aregger, Department of Nephrology/Hypertension, Freiburgstrasse 15, University of Bern, CH-3010 Bern, Switzerland. Tel: +41-31-632-21-98; Fax: +41-31-632-97-34; E-mail: fabienne.aregger{at}insel.ch
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Abstract |
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Background. Transcatheter aortic valve implantation (TAVI) for high-risk and inoperable patients with severe aortic stenosis is an emerging procedure in cardiovascular medicine. Little is known of the impact of TAVI on renal function.
Methods. We analysed retrospectively renal baseline characteristics and outcome in 58 patients including 2 patients on chronic haemodialysis undergoing TAVI at our institution. Acute kidney injury (AKI) was defined according to the RIFLE classification.
Results. Fifty-eight patients with severe symptomatic aortic stenosis not considered suitable for conventional surgical valve replacement with a mean age of 83 ± 5 years underwent TAVI. Two patients died during transfemoral valve implantation and two patients in the first month after TAVI resulting in a 30-day mortality of 6.9%. Vascular access was transfemoral in 46 patients and transapical in 12. Estimated glomerular filtration rate (eGFR) increased in 30 patients (56%). Fifteen patients (28%) developed AKI, of which four patients had to be dialyzed temporarily and one remained on chronic renal replacement therapy. Risk factors for AKI comprised, among others, transapical access, number of blood transfusions, postinterventional thrombocytopaenia and severe inflammatory response syndrome (SIRS).
Conclusions. TAVI is feasible in patients with a high burden of comorbidities and in patients with pre-existing end-stage renal disease who would be otherwise not considered as candidates for conventional aortic valve replacement. Although GFR improved in more than half of the patients, this benefit was associated with a risk of postinterventional AKI. Future investigations should define preventive measures of peri-procedural kidney injury.
Keywords: acute kidney injury; severe inflammatory response syndrome; transcatheter aortic valve implantation
Received for publication: 20.11.08
Accepted in revised form: 19. 1.09
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