Comparison of acute kidney injury classifications in patients undergoing transcatheter aortic valve implantation: Predictors and long-term outcomes.
BACKGROUND
Acute kidney injury (AKI) was demonstrated to adversely affect outcome in patients undergoing transcatheter aortic valve implantation (TAVI). We compared predictors for AKI and associated outcomes according to various definitions among patients undergoing TAVI in a tertiary medical center.


METHODS
Two-hundred and seventeen TAVI patients were evaluated for the occurrence of AKI according to Kidney Disease Improving Global Outcomes (KDIGO)/Valve Academic Research Consortium (VARC-2) and Risk Injury Failure Loss End-Stage (RIFLE) definitions. Multivariate analysis was conducted to assess predictors of AKI. Cox hazard ratio was used to evaluate long-term mortality in this patient population.


RESULTS
AKI occurred in 23 and 21% of patients (n = 49, n = 46) according to KDIGO/VARC-2 and RIFLE definitions, respectively, with an approximate 10% of disagreement between both systems. Predictors of AKI according to KDIGO/VARC-2 were chronic obstructive pulmonary disease (COPD; OR = 2.66, P = 0.01), PVD (OR = 3.45, P = 0.02) and a lower baseline eGFR (OR = 1.03 per 1 mL/min/1.73 m(2) decrease, P = 0.02). While BMI (OR = 1.12, P = 0.01), prior ischemic heart disease (OR = 2.35, P = 0.04) and COPD (OR = 2.18, P = 0.04) were associated with AKI as defined by the RIFLE definition. AKI defined by either classification was independently associated with long-term mortality (HR = 1.63, for the KDIGO/VARC-2 definition and HR = 1.60 for RIFLE definition, P = 0.04 for both models), with borderline superiority of the KDIGO/VARC-2 classification.


CONCLUSIONS
Different clinical characteristics predict the occurrence of AKI after TAVI when RIFLE and KDIGO/VARC-2 classifications are used. Both classification systems of AKI identify patients with increased risk for long-term mortality, with superiority of the KDIGO/VARC-2 definition, which should be used for AKI grading.
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Edward
E
Koifman
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Amit
A
Segev
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Paul
P
Fefer
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Israel
I
Barbash
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Avi
A
Sabbag
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Diego
D
Medvedovsky
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Dan
D
Spiegelstein
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Ashraf
A
Hamdan
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Ilan
I
Hay
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Ehud
E
Raanani
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Ilan
I
Goldenberg
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Israel.
Victor
V
Guetta
D058186:Acute Kidney Injury / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D009626:Terminology as Topic; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
acute; aortic valve disease; percutaneous intervention; percutaneous valve therapy; renal disease