Kliuk-Ben Bassat Orit, Sadon Sapir, Sirota Svetlana, Steinvil Arie, Konigstein Maayan, Halkin Amir, Bazan Samuel, Grupper Ayelet, Banai Shmuel, Finkelstein Ariel, Arbel Yaron
Department of Nephrology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
Department of Cardiology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
Can J Kidney Health Dis. 2021 Jun 4;8:20543581211018029. doi: 10.1177/20543581211018029. eCollection 2021.
Transcatheter aortic valve replacement (TAVR), although associated with an increased risk for acute kidney injury (AKI), may also result in improvement in renal function.
The aim of this study is to evaluate the magnitude of kidney function improvement (KFI) after TAVR and to assess its significance on long-term mortality.
This is a prospective single center study.
The study was conducted in cardiology department, interventional unit, in a tertiary hospital.
The cohort included 1321 patients who underwent TAVR.
Serum creatinine level was measured at baseline, before the procedure, and over the next 7 days or until discharge.
Kidney function improvement was defined as the mirror image of AKI, a reduction in pre-procedural to post-procedural minimal creatinine of more than 0.3 mg/dL, or a ratio of post-procedural minimal creatinine to pre-procedural creatinine of less than 0.66, up to 7 days after the procedure. Patients were categorized and compared for clinical endpoints according to post-procedural renal function change into 3 groups: KFI, AKI, or preserved kidney function (PKF). The primary endpoint was long-term all-cause mortality.
The incidence of KFI was 5%. In 55 out of 66 patients patients, the improvement in kidney function was minor and of unclear clinical significance. Acute kidney injury occurred in 19.1%. Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m was a predictor of KFI after multivariable analysis (odds ratio = 0.93 to develop KFI; confidence interval [95% CI]: 0.91-0.95, < .001). Patients in the KFI group had a higher Society of Thoracic Surgery (STS) score than other groups. Mortality rate did not differ between KFI group and PKF group (43.9% in KFI group and 33.8% in PKF group) but was significantly higher in the AKI group (60.7%, < .001).
The following are the limitations: heterozygous definitions of KFI within different studies and a single center study. Although data were collected prospectively, analysis plan was defined after data collection.
Improvement in kidney function following TAVR was not a common phenomenon in our cohort and did not reduce overall mortality rate.
经导管主动脉瓣置换术（TAVR）虽然与急性肾损伤（AKI）风险增加相关，但也可能导致肾功能改善。
本研究旨在评估TAVR术后肾功能改善（KFI）的程度，并评估其对长期死亡率的意义。
这是一项前瞻性单中心研究。
该研究在一家三级医院的心脏病学介入科室进行。
队列包括1321例行TAVR的患者。
在基线、手术前以及接下来7天或直至出院时测量血清肌酐水平。
肾功能改善定义为AKI的镜像，即术前至术后最低肌酐水平降低超过0.3mg/dL，或术后最低肌酐水平与术前肌酐水平之比小于0.66，直至术后7天。根据术后肾功能变化将患者分为3组：KFI、AKI或肾功能保留（PKF）组，并比较临床终点。主要终点是长期全因死亡率。
KFI发生率为5%。66例患者中有55例肾功能改善轻微，临床意义不明确。急性肾损伤发生率为19.1%。多变量分析后，估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²是KFI的预测因素（发生KFI的比值比=0.93；置信区间[95%CI]：0.91-0.95，P<.001）。KFI组患者的胸外科医师协会（STS）评分高于其他组。KFI组和PKF组的死亡率无差异（KFI组为43.9%，PKF组为33.8%），但AKI组显著更高（60.7%，P<.001）。
以下是局限性：不同研究中KFI的定义存在差异，且为单中心研究。尽管数据是前瞻性收集的，但分析计划在数据收集后确定。
在我们的队列中，TAVR术后肾功能改善并非常见现象，也未降低总体死亡率。
