title: Acute kidney injury after transcatheter aortic valve replacement: a systematic review and meta-analysis.
abstract: BACKGROUND
  The objective of this meta-analysis was to evaluate the risk of acute kidney injury (AKI) in patients who underwent transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  A literature search was performed using MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception through October, 2014. Studies that reported relative risks, ORs, or hazard ratios comparing the AKI risk in patients who underwent TAVR versus those who underwent surgical aortic valve replacement were included. We performed the pre-specified sensitivity analysis including only propensity score-based studies. Mortality risk was evaluated among the studies that reported AKI outcome. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
  
  
  RESULTS
  Three randomized controlled trials (RCTs) with 1,852 patients and 14 cohort studies with 3,113 patients were analyzed to assess the AKI risk in patients undergoing TAVR. The pooled RRs of AKI in patients undergoing TAVR were 0.65 (95% CI 0.36-1.15, I(2) = 75%) in the analysis of RCTs and propensity score-based studies and 0.76 (95% CI 0.44-1.34, I(2) = 79%) in the analysis of observational studies. Sensitivity analysis in RCTs and propensity score-based studies using a standard AKI definition demonstrated a significant association between TAVR and lower AKI risk (RR 0.35, 95% CI 0.25-0.50, I(2) = 0%). Our meta-analyses of RCTs and propensity score-based studies did not find associations between TAVR and reduced risks of severe AKI requiring dialysis (RR 0.82, 95% CI 0.38-1.79, I(2) = 63%).
  
  
  CONCLUSIONS
  Our meta-analysis demonstrates an association between TAVR and lower AKI risk.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
authors.forename: Narat
authors.initials: N
authors.lastname: Srivali
authors.forename: Patompong
authors.initials: P
authors.lastname: Ungprasert
authors.forename: Wonngarm
authors.initials: W
authors.lastname: Kittanamongkolchai
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.forename: Kianoush B
authors.initials: KB
authors.lastname: Kashani
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D065467:Transcatheter Aortic Valve Replacement