Interventional Cardiology and Vascular Medicine, Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7872, San Antonio, TX 78229-3900 USA.
J Invasive Cardiol. 2020 Apr;32(4):138-141. doi: 10.25270/jic/19.00349. Epub 2020 Jan 15.
Acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR) is a known complication. The prospective validation of various AKI definitions and estimated baseline renal function equations in the context of TAVR remains an ongoing area of research. This study examined the Valve Academic Research Consortium (VARC) 1 and 2 criteria for AKI, and impact of three estimated glomerular filtration rate (eGFR) equations (CKD-EPI, MDRD, and Cockcroft-Gault) on AKI incidence in TAVR patients.
Retrospective review of 120 consecutive TAVR procedures over a 4-year period was performed. AKI, including stage, was defined using the VARC 1 and VARC 2 criteria. Univariate and multivariate analyses were performed for association between AKI and known patient, hemodynamic, and procedural variables. Further logistic regression, stepwise logistic regression, and association plots were performed for the three different eGFR calculations.
AKI occurred in 22% of VARC 1 patients and 23% of VARC 2 patients. On multivariate analysis, baseline eGFR was predictive of stage 1 AKI by CKD-EPI classification (VARC 1: odds ratio [OR], 0.93; 95% confidence interval [CI], 0.88-0.99; P=.02; VARC 2: OR, 0.93; 95% CI, 0.87-0.99; P=.03) and MDRD (OR, 0.93; 95% CI, 0.88-0.99; P=.03). Non-transfemoral approach was predictive of stage 1 AKI by VARC 2 (OR, 33.33; 95% CI, 1.6-696.41; P=.02).
The risk factor associations for AKI post TAVR vary by definitions used. Decreased GFR at baseline by both MDRD and CKD-EPI and non-transfemoral approach were associated with an increased risk of AKI post TAVR.
经导管主动脉瓣置换术（TAVR）后发生急性肾损伤（AKI）是已知的并发症。在 TAVR 背景下，对各种 AKI 定义和估算的基线肾功能方程的前瞻性验证仍然是一个正在进行的研究领域。本研究检查了 Valve Academic Research Consortium（VARC）1 和 2 版 AKI 标准，以及三种估算肾小球滤过率（eGFR）方程（CKD-EPI、MDRD 和 Cockcroft-Gault）对 TAVR 患者 AKI 发生率的影响。
对 4 年内连续 120 例 TAVR 手术进行回顾性分析。使用 VARC 1 和 VARC 2 标准定义 AKI，包括分期。对 AKI 与已知患者、血流动力学和手术变量之间的关系进行单变量和多变量分析。进一步进行了 logistic 回归、逐步 logistic 回归和三种不同 eGFR 计算的关联图。
VARC 1 患者中有 22%发生 AKI，VARC 2 患者中有 23%发生 AKI。多变量分析显示，基线 eGFR 可预测 CKD-EPI 分类的 1 期 AKI（VARC 1：优势比[OR]0.93；95%置信区间[CI]0.88-0.99；P=.02；VARC 2：OR0.93；95%CI0.87-0.99；P=.03）和 MDRD（OR0.93；95%CI0.88-0.99；P=.03）。非经股动脉入路是 VARC 2 版 1 期 AKI 的预测因素（OR33.33；95%CI1.6-696.41；P=.02）。
TAVR 后 AKI 的危险因素关联因使用的定义而异。MDRD 和 CKD-EPI 基线时 GFR 降低以及非经股动脉入路与 TAVR 后 AKI 风险增加相关。
