title: Factors Contributing to Acute Kidney Injury and the Impact on Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) patients are at a high risk of acute kidney injury (AKI). This study aimed to investigate AKI and the relationship with iodinated contrast media (ICM), whether there are significant pre- or peri- procedural variables predicting AKI, and whether AKI impacts on hospital length of stay and mortality.
  
  
  METHODS
  Serum creatinine (SC) levels pre- and post- (peak) TAVR were recorded in 209 consecutive TAVR patients. AKI was defined by the Valve Academic Research Consortium 2 (VARC2) criteria. Baseline characteristics, procedural variables, hospital length of stay (LOS) and mortality at 72hours, 30 days and one year were analysed.
  
  
  RESULTS
  Eighty-two of 209 (39%) patients suffered AKI. Mean ICM volume was 228cc, with no difference between patients with AKI and those with no AKI (227cc (213-240(95%CI)) vs 231cc (212-250) p=0.700)). Univariate and multivariate analysis demonstrated that chronic kidney disease, respiratory failure, previous stroke, the need for blood transfusion and valve repositioning were all predictors of AKI. Acute kidney injury increased LOS (5.6 days (3.8 - 7.5) vs 3.2 days (2.6 - 3.9) no AKI (P=0.004)) but was not linked to increased mortality. Mortality rates did increase with AKI severity.
  
  
  CONCLUSIONS
  Acute kidney injury is a common complication of TAVR. The severity of AKI is important in determining mortality. Acute kidney injury appears to be independent of ICM use but pre-existing renal impairment and respiratory failure were predictors for AKI. Transcatheter aortic valve replacement device repositioning or retrieval was identified as a new risk factor impacting on AKI.
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St Lucia, Queensland, Australia. Electronic address: Jimcrowhurst@hotmail.com.
authors.forename: James A
authors.initials: JA
authors.lastname: Crowhurst
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Savage
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia.
authors.forename: Vijayakumar
authors.initials: V
authors.lastname: Subban
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Incani
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Owen C
authors.initials: OC
authors.lastname: Raffel
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Karl
authors.initials: K
authors.lastname: Poon
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Dale
authors.initials: D
authors.lastname: Murdoch
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia.
authors.forename: Ramkrishna
authors.initials: R
authors.lastname: Saireddy
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Clarke
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St Lucia, Queensland, Australia; Holy Spirit Northside Hospital, Chermside, Queensland, Australia.
authors.forename: Constantine
authors.initials: C
authors.lastname: Aroney
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bett
authors.affiliation: The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000401:mortality*; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality*; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
chemical_list: D003404:Creatinine
keywords: Acute kidney injury; Chronic kidney disease; Co-morbidities; Contrast media; Renal failure; TAVR