Charat Thongprayoon
1, Wisit Cheungpasitporn
1, Wonngarm Kittanamongkolchai
1, Narat Srivali
2, Kevin L Greason
3, Kianoush Kashani
1,2*1 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
2 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
3 Division of Cardiovascular Surgery, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Abstract
Introduction: The patients selected for transcatheter aortic valve replacement (TAVR) usually have a high prevalence of chronic kidney disease (CKD). Little is known regarding the impact of TAVR on changes in renal function.Objectives: This study aimed to assess the change in estimated glomerular filtration rate (eGFR) after TAVR.Patients and Methods: Adult patients with aortic stenosis (AS) who underwent TAVR between January 2008 and June 2014, at Mayo Clinic, Rochester, MN. Changes in renal function during six months follow-up were evaluated.Results: Of 386 patients undergoing TAVR, 106 (28%) developed acute kidney injury (AKI). There was significant reduction in eGFR at the hospital discharge and at 6 months post-TAVR in AKI patients in comparison with non-AKI individuals, (mean differences -7.1; 95% CI -9.8, -4.3 mL/min/1.73 m2, P < 0.001 and -4.2; 95% CI -7.1, -1.3 mL/min/1.73 m2, P = 0.005, respectively). In non-AKI patients with baseline eGFR ≥60 mL/min/1.73 m2, there was a modest decrease in eGFR at 6 month (mean difference -4.0; 95% CI -6.4, -1.6 ml/min/1.73 m2, P = 0.001). Conversely, in non-AKI patients with eGFR 30-59 and <30 mL/min/1.73 m2, there was an increase in eGFR at 6 months (mean difference 2.4; 95% CI 0.8, 2.4 mL/min/1.73 m2; P = 0.004 and 5.3; 95% CI 2.8, 7.8 mL/min/1.73 m2; P = 0.001, respectively).Conclusion: In patients undergoing TAVR, change in renal function is significantly related to pre-procedural kidney function. AKI significantly impacts renal function at six months post TAVR. CKD patients who do not develop AKI, may benefit from TAVR by an increase in eGFR at six months.
Implication for health policy/practice/research/medical education:
Impact of transcatheter aortic valve replacement (TAVR) on renal function especially in patients with chronic kidney disease (CKD) is unclear. In this current study, we investigated the change in eGFR following TAVR in non-advanced CKD patients with severe aortic stenosis (AS) stratified by levels of eGFR (≥ 60, 30-59, and <30 mL/min/1.73m2). Our findings were as follows; 1) acute kidney injury (AKI) significantly decreased eGFR at 6 months after TAVR and 2) In patients with no AKI after TAVR, individuals with CKD (particularly eGFR <30 mL/min/1.73m2) had a significant increase in eGFR (decrease in SCr) at 6 months.
Please cite this paper as: Thongprayoon C, Cheungpasitporn W, Kittanamongkolchai W, Srivali N, Greason KL, Kashani KB. Changes in kidney function among patients undergoing transcatheter aortic valve replacement. J Renal Inj Prev. 2017;6(3):216-221. DOI: 10.15171/jrip.2017.41.