title: Chronic kidney disease is not associated with a higher risk for mortality or acute kidney injury in transcatheter aortic valve implantation.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option for surgical high-risk patients with severe aortic stenosis (AS). Many of these patients suffer from chronic kidney disease (CKD), which substantially increases the risk for acute kidney injury (AKI), need for renal replacement therapy (RRT) and mortality after surgical aortic valve repair. The impact of pre-existing CKD for the outcome of TAVI is still unclear.
  
  
  METHODS
  We retrospectively evaluated 199 consecutive patients with symptomatic high-grade AS undergoing TAVI with the CoreValve prosthesis at our centre. We analysed incidence and predictive factors for AKI, RRT and mortality in patients with and without CKD (defined as an estimated glomerular filtration rate <60 mL/min).
  
  
  RESULTS
  26.8% of the patients suffered from AKI, 4.9% needed RRT and 5.5% died. All patients on chronic haemodialysis (n = 10) survived. There were no significant differences between patients with or without CKD concerning the incidence of AKI, RRT and mortality. Age, peripheral vascular disease and the need for blood transfusion were independently associated with AKI. AKI proved to be a predictive factor for mortality.
  
  
  CONCLUSIONS
  Transcatheter aortic valve replacement with the CoreValve prosthesis does not seem to bear an increased risk for patients with CKD. For surgical high-risk patients with severe AS, a more liberal consideration for TAVI as an alternative to open surgery might be justified.
authors.affiliation: Medizinische Klinik und Poliklinik I, Schwerpunkt Nephrologie, Ludwig-Maximilians-Universitat Munchen, KlinikumGroshadern, Munich, Germany. matthias.wessely@med.uni-muenchen.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Wessely
authors.forename: Simon
authors.initials: S
authors.lastname: Rau
authors.forename: Philipp
authors.initials: P
authors.lastname: Lange
authors.forename: Katharina
authors.initials: K
authors.lastname: Kehl
authors.forename: Vivian
authors.initials: V
authors.lastname: Renz
authors.forename: Ulf
authors.initials: U
authors.lastname: Schönermarck
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.forename: Michael
authors.initials: M
authors.lastname: Fischereder
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality*; D018570:Risk Assessment; D015996:Survival Rate