title: Inhospital and Post-discharge Changes in Renal Function After Transcatheter Aortic Valve Replacement.
abstract: The aim of this study was to determine the influence of inhospital and post-discharge worsening renal function (WRF) on prognosis after transcatheter aortic valve replacement (TAVR). Severe chronic kidney disease and inhospital WRF are both associated with poor outcomes after TAVR. There are no data available on post-discharge WRF and outcomes. This was a single-center study evaluating all TAVR from June 1, 2008, to June 31, 2014. WRF was defined as an increase in serum creatinine of ≥0.3 mg/dl. Inhospital WRF was measured from day 0 until discharge or day 7 if the hospitalization was >7 days. Post-discharge WRF was measured at 30 days after discharge. Descriptive statistics, Kaplan-Meier time-to-event analysis, and multivariate logistic regression were used. In a series of 208 patients who underwent TAVR, 204 with complete renal function data were used in the inhospital analysis and 168 who returned for the 30-day follow-up were used in the post-discharge analysis. Inhospital WRF was seen in 28%, whereas post-discharge WRF in 12%. Inhospital and post-discharge WRF were associated with lower rates of survival; however, after multivariate analysis, only post-discharge WRF remained a predictor of 1-year mortality (hazard ratio 1.18, p = 0.030 for every 1 mg/dl increase in serum creatinine). In conclusion, the rate of inhospital WRF is higher than the rate of post-discharge WRF after TAVR, and post-discharge WRF is more predictive of mortality than inhospital WRF.
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: John E A
authors.initials: JEA
authors.lastname: Blair
authors.affiliation: Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Kent
authors.initials: K
authors.lastname: Brummel
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Friedman
authors.affiliation: Scripps Clinic, Scripps Prebys Cardiovascular Institute, La Jolla, California.
authors.forename: Prashant
authors.initials: P
authors.lastname: Atri
authors.affiliation: Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ranya N
authors.initials: RN
authors.lastname: Sweis
authors.affiliation: Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Hyde
authors.initials: H
authors.lastname: Russell
authors.affiliation: Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Ricciardi
authors.affiliation: Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.affiliation: Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Davidson
authors.affiliation: Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: jflahert@nm.org.
authors.forename: James D
authors.initials: JD
authors.lastname: Flaherty
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D003404:Creatinine / Q000097:blood*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D010351:Patient Discharge; D011183:Postoperative Complications; D011379:Prognosis; D051437:Renal Insufficiency / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
chemical_list: D003404:Creatinine