Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Background: Reported rates of acute kidney injury (AKI) after transcatheter aortic valve replacement in small observational studies vary widely. Methods: Patients who underwent transcatheter aortic valve replacement in the United States between January 1, 2016 and June 30, 2018, were included. Patients without reported baseline or peak creatinine values and those who were previously on hemodialysis were excluded. AKI was defined using AKI Network criteria from stages 0 to 3. Logistic regression was used to assess patient and clinical factors associated with incident in-hospital AKI. Among patients with available data from the Center for Medicare and Medicaid Services administrative files, we compared 1-year mortality among patients with and without AKI. Results: Of 107 814 study patients, 11 566 (10.7%) experienced postprocedural AKI. Among patients who developed AKI, 10 220 (9.5%) experienced stage 1 AKI, 134 (0.1%) stage 2 AKI, and 1212 (1.1%) stage 3 AKI. Race, baseline comorbidities, clinical presentation, and procedural factors were associated with the development of stage 3 AKI. In Center for Medicare and Medicaid Services–linked analyses of 62 757 (58.2%) patients, those with AKI had higher adjusted hazard ratio for mortality at 1 year compared with patients who did not experience AKI (stage 1 AKI: adjusted hazard ratio, 2.7 [95% CI, 2.5–2.8], P <0.001; stage 2 AKI: adjusted hazard ratio, 10.4 [95% CI, 7.0–15.4], P <0.001; stage 3 AKI: adjusted hazard ratio, 7.0 [95% CI, 6.0–8.2], P <0.001). Conclusions: Using data from the Society of Thoracic Surgeons/American College of Cardiology National Cardiovascular Data Registry Transcatheter Valve Therapy Registry registry, we found that AKI is common after transcatheter aortic valve replacement, with over 10% of patients developing postprocedure AKI. Patients who developed stage 3 AKI had 7× higher adjusted 1-year mortality compared with patients who did not develop AKI.