Predicting acute kidney injury following transcatheter aortic valve replacement

Purpose: Acute kidney injury occurs in up to a quarter of patients following transcatheter aortic valve replacement (TAVR) and has been associated with increased short and long-term mortality rates. A variety of patient characteristics predictive of post-TAVR acute kidney injury (AKI) have been identified, however discrepancies among studies exist almost uniformly. We investigated the hypothesis that the change in glomerular filtration rate (δGFR) in response to contrast administered during pre-TAVR coronary angiography is predictive of ?GFR post-TAVR. Methods: The study comprised 195 patients who underwent TAVR at a single center between August 2008 and June 2015 and were prospectively included in the CAPITAL TAVR registry. Multiple linear regression analysis was conducted to estimate the effect of independent variables on the change in renal function post-TAVR. Results: There was no relationship identified between the ?GFR post-angiogram and the δGFR post-TAVR (r=0.043, P=0.582). Multiple linear regression analysis revealed that a significant amount of the change in renal function post-TAVR can be explained by the patient's baseline creatinine (beta coefficient, -0.310, P<0.001) and the volume of contrast administered during TAVR (beta coefficient, -0.225, P0.002). The presence of an AKI following diagnostic coronary angiogram was not predictive of the change in renal function post-TAVR using the Valve Academic Research Consortium (VARC) definitions: VARC1 (beta coefficient, 0.102, P=0.170) or VARC2 (beta coefficient, 0.124, P=0.099). Conclusions: A patient's previous renal response to contrast administered during coronary angiogram is not predictive of their response post-TAVR; instead, as demonstrated previously, baseline renal function and contrast volume administered are two of the most important predictors of post-TAVR AKI.