title: Impact of kidney function on mortality after transcatheter valve implantation in patients with severe aortic valvular stenosis.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is an accepted alternative for patients with severe aortic valve stenosis who cannot undergo surgery. Acute kidney injury (AKI) is a serious complication in any invasive cardiovascular intervention. The objectives of the study were to determine (i) the influence of kidney function before TAVI and (ii) the impact of changes in kidney function after TAVI, including acute kidney injury (AKI), on mortality.
  
  
  RESULTS
  A total of 540 patients undergoing TAVI were included. Patients were divided into three groups according to glomerular filtration rate (GFR) before TAVI (A: normal renal function i.e. GFR ≥60ml/min; B: impaired renal function i.e. GFR 30-59ml/min; C: severe impaired renal function i.e. GFR <30ml/min). Multivariate analysis showed a significant impact of GFR on mortality (p<0.0008). Subgroup analysis showed significant differences between the groups in 30-day (A: 5.4%, B: 9.0%, C: 25.0%) and 12-month mortality (A: 15.0%, B: 32.0%, C: 49%). Patients who had an increase in GFR after TAVI by more than 22% (p=0.0068) had an improved survival rate, whereas a decrease in GFR by more than 15% was associated with an increased mortality rate (p=0.0051). AKI occurred in 30 patients (5.6%), of which 22 patients (73.3%) died within 12months.
  
  
  CONCLUSIONS
  Outcome is significantly related to pre-procedural kidney function. In addition, changes in kidney function after TAVI have a significant impact on mortality. Due to a very poor prognosis in patients with AKI, any effort to prevent this serious complication after TAVI needs to be taken.
authors.affiliation: Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Voigtländer
authors.affiliation: Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany.
authors.forename: Jury
authors.initials: J
authors.lastname: Schewel
authors.affiliation: Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Martin
authors.affiliation: Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany.
authors.forename: Dimitry
authors.initials: D
authors.lastname: Schewel
authors.affiliation: Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
authors.affiliation: Asklepios Proresearch, Clinical Research and Development, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.affiliation: Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thielsen
authors.affiliation: Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Division of Cardiology, Asklepios Clinics St. Georg Hospital, Hamburg, Germany. Electronic address: u.schaefer@uke.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D016896:Treatment Outcome
keywords: Acute kidney injury; Aortic stenosis; Kidney function; Transcatheter aortic valve implantation