title: Acute kidney injury assessed by cystatin C after transcatheter aortic valve implantation and late renal dysfunction.
abstract: OBJECTIVE
  The aim of the present study was to evaluate acute kidney injury (AKI) with cystatin C following transcatheter aortic valve implantation (TAVI) and to assess the impact of postoperative AKI on outcome and late renal function.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  Single, tertiary referral center.
  
  
  METHODS
  Sixty-eight consecutive patients with severe aortic stenosis and advanced comorbidity.
  
  
  METHODS
  Blood samples were collected on 4 occasions pre- and postoperatively to determine levels of s-creatinine and cystatin C. Additionally, a sample was collected at followup 12 months postoperatively for the determination of s-creatinine.
  
  
  RESULTS
  The mean preoperative eGFR (s-creatinine) was 67±24 mL/min/1.73 m² compared to 45±21 mL/min/1.73 m² with eGFR (cystatin C) (p<0.001). Postoperative AKI was diagnosed in 25 patients (39%) with eGFR (cystatin C), compared to 21 patients (33%) with GFR (s-creatinine) and the RIFLE criteria. The 90-day mortality was 14.3% for the AKI+group and 2.3% for the AKI-group (p = 0.099). At 12 months followup, renal function remained impaired in patients with postoperative AKI and deteriorated in patients without.
  
  
  CONCLUSIONS
  The risk of postoperative AKI is considerable following TAVI, with an increased risk of early mortality for AKI+patients. Cystatin C may be a valuable adjunct to the established biomarker s-creatinine for preoperative risk assessment and for early postoperative diagnosis of AKI. The acute postoperative renal impairment in patients with AKI does not fully recover in the long term. There is a progressive renal impairment in both groups postoperatively, the etiology probably being multifactorial.
authors: Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden.
authors: Malin
authors: M
authors: Johansson
authors: Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden. Electronic address: shahab.nozohoor@med.lu.se.
authors: Shahab
authors: S
authors: Nozohoor
authors: Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden.
authors: Henrik
authors: H
authors: Bjursten
authors: Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden.
authors: Per Ola
authors: PO
authors: Kimblad
authors: Department of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden.
authors: Johan
authors: J
authors: Sjögren
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine
keywords: acute kidney injury; cystatin-C; outcome; transcatheter aortic valve implantation