经导管主动脉瓣置换术后急性肾损伤和急性肾恢复。
Acute kidney injury and acute kidney recovery following Transcatheter Aortic Valve Replacement.
机构信息
Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.
INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France.
出版信息
PLoS One. 2021 Aug 10;16(8):e0255806. doi: 10.1371/journal.pone.0255806. eCollection 2021.
BACKGROUND
Acute kidney injury (AKI) is associated with a dismal prognosis in Transcatheter Aortic Valve replacement (TAVR). Acute kidney recovery (AKR), a phenomenon reverse to AKI has recently been associated with better outcomes.
METHODS
Between November 2012 to May 2018, we explored consecutive patients referred to our Heart Valve Center for TAVR. AKI was defined according to the VARC-2 definition. Mirroring the VARC-2 definition of AKI, AKR was defined as a decrease in serum creatinine (≥50%) or ≥25% improvement in GFR up to 72 hours after TAVR.
RESULTS
AKI and AKR were respectively observed in 8.3 and 15.7% of the 574 patients included. AKI and AKR patients were associated to more advanced kidney disease at baseline. At a median follow-up of 608 days (range 355-893), AKI and AKR patients experienced an increased cardiovascular mortality compared to unchanged renal function patients (14.6% and 17.8% respectively, vs. 8.1%, CI 95%, p<0.022). Chronic kidney disease, (HR: 3.9; 95% CI 1.7-9.2; p < 0.001) was the strongest independent factor associated with AKI similarly to baseline creatinine level (HR: 1; 95% CI 1 to 1.1 p < 0.001) for AKR. 72-hours post procedural AKR (HR: 2.26; 95% CI 1.14 to 4.88; p = 0.021) was the strongest independent predictor of CV mortality.
CONCLUSIONS
Both AKR and AKI negatively impact long term clinical outcomes of patients undergoing TAVR.
背景
急性肾损伤（AKI）与经导管主动脉瓣置换术（TAVR）的预后不良相关。急性肾恢复（AKR）是 AKI 的相反现象，最近与更好的结果相关。
方法
在 2012 年 11 月至 2018 年 5 月期间，我们研究了连续转介到我们的心脏瓣膜中心进行 TAVR 的患者。AKI 根据 VARC-2 定义进行定义。与 VARC-2 定义的 AKI 相似，AKR 定义为 TAVR 后 72 小时内血清肌酐降低（≥50%）或 GFR 提高≥25%。
结果
在纳入的 574 名患者中，分别观察到 8.3%和 15.7%的患者发生 AKI 和 AKR。AKI 和 AKR 患者在基线时与更严重的肾脏疾病相关。在中位随访 608 天（范围 355-893）期间，与肾功能无变化的患者相比，AKI 和 AKR 患者的心血管死亡率增加（分别为 14.6%和 17.8%，95%CI，p<0.022）。慢性肾脏病（HR：3.9；95%CI 1.7-9.2；p < 0.001）是与 AKI 最相关的独立因素，与基线肌酐水平（HR：1；95%CI 1 至 1.1，p < 0.001）相似。术后 72 小时的 AKR（HR：2.26；95%CI 1.14 至 4.88；p = 0.021）是心血管死亡率的最强独立预测因子。
结论
AKR 和 AKI 均对接受 TAVR 的患者的长期临床结局产生负面影响。
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