title: Kidney injury and mortality after transcatheter aortic valve implantation in a routine clinical cohort.
abstract: OBJECTIVE
  We aimed at identifying predictors of renal impairment and its impact on long-term outcome after transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Renal impairment is common in mostly elderly, multimorbid patients undergoing TAVI. The risk of periprocedural renal function impairment and its association with outcome is incompletely understood.
  
  
  METHODS
  In 458 consecutive patients (mean age, 80.6 ± 7.0 years, 52.2% women) who underwent routine TAVI procedures, we assessed estimated glomerular filtration rate (eGFR) at baseline, during 72-hr postprocedure and at discharge. Over a median follow-up of 0.96 years, we observed 142 deaths.
  
  
  RESULTS
  In multivariable-adjusted models, predictors of renal function deterioration within 72 hr were baseline eGFR (β = 0.83, 95% confidence interval [CI] = 0.76/0.91; P < 0.0001), body mass index (β = -1.20, 95% CI = 1.77/-0.62; P < 0.0001), and major access site complications (β = -14.82, 95% CI = -26.52/-3.11; P = 0.013) including bleeding (β = -11.97, 95% CI = -21.05/-2.89; P = 0.0099). Strongest renal function predictor of 1-year mortality in risk factor adjusted analyses was the change of eGFR within 72 hr (odds ratio, 0.97; 95% CI = 0.96/0.98; P < 0.0001). The addition of information on the change of eGFR increased the C-statistic of the logistic EuroSCORE (P = 0.021).
  
  
  CONCLUSIONS
  In our routine TAVI sample, baseline eGFR, body mass index, and major access site complications mainly owing to bleeding were correlates of acute kidney injury after TAVI. Acute renal impairment was a risk factor for mortality and adverse cardiovascular events which provided risk information beyond the EuroSCORE.
authors: Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
authors: Renate B
authors: RB
authors: Schnabel
authors: Moritz
authors: M
authors: Seiffert
authors: Sandra
authors: S
authors: Wilde
authors: Johannes
authors: J
authors: Schirmer
authors: Dietmar H
authors: DH
authors: Koschyk
authors: Lenard
authors: L
authors: Conradi
authors: Francisco
authors: F
authors: Ojeda
authors: Stephan
authors: S
authors: Baldus
authors: Hermann
authors: H
authors: Reichenspurner
authors: Stefan
authors: S
authors: Blankenberg
authors: Hendrik
authors: H
authors: Treede
authors: Patrick
authors: P
authors: Diemert
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015992:Body Mass Index; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005919:Glomerular Filtration Rate; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: CHF-congestive heart failure; CRI-chronic renal insufficiency; VALV-valvular heart disease