title: Predictors and outcome of acute kidney injury after transcatheter aortic valve implantation: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The aim of this systematic review and meta-analysis was to investigate the predictors and outcome of acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI).
  
  
  RESULTS
  There were 35 articles recruiting 13,256 patients included in our study. Hypertension (odds ratio [OR] 1.92, 95% CI: 1.44 to 2.56), diabetes mellitus (OR 1.33, 95% CI: 1.20 to 1.47), peripheral artery disease (OR 1.28, 95% CI: 1.14 to 1.45) and a left ventricular ejection fraction <40% (OR 1.50, 95% CI: 1.19 to 1.88) were identified as significant independent predictors of AKI. In addition to the aforementioned comorbidities, procedure-related/post-TAVI factors such as transapical access (OR 1.68, 95% CI: 1.44 to 1.97), major bleeding (OR 1.82, 95% CI: 1.37 to 2.40) and transfusion (OR 1.30, 95% CI: 1.12 to 1.51) were also associated with a higher risk of AKI. Importantly, the risk of short-term all-cause death increased progressively with the aggravating severity of AKI (OR, 30 days: stage 1: 3.41; stage 2: 4.0; stage 3: 11.02; one year: stage 1: 1.95; stage 2: 2.82; stage 3: 7.34), as determined by a univariate analysis. After eliminating confounders, AKI remained linked to a higher risk for both short-term (30 days: HR 2.12, 95% CI: 1.59 to 2.83) and long-term (≥3 years: HR 1.37, 95% CI: 1.27 to 1.48) all-cause mortality.
  
  
  CONCLUSIONS
  The reason for the occurrence of AKI was multifactorial, including baseline characteristics, procedure-related and post-TAVI factors. It appeared that even stage 1 AKI exerted detrimental effects on survival within one year, and AKI was also independently linked to mortality beyond three years.
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yan-Biao
authors.initials: YB
authors.lastname: Liao
authors.forename: Xue-Xue
authors.initials: XX
authors.lastname: Deng
authors.forename: Yang
authors.initials: Y
authors.lastname: Meng
authors.forename: Zhen-Gang
authors.initials: ZG
authors.lastname: Zhao
authors.forename: Tian-Yuan
authors.initials: TY
authors.lastname: Xiong
authors.forename: Xiang-Jun
authors.initials: XJ
authors.lastname: Meng
authors.forename: Zhi-Liang
authors.initials: ZL
authors.lastname: Zuo
authors.forename: Yi-Jian
authors.initials: YJ
authors.lastname: Li
authors.forename: Jia-Yu
authors.initials: JY
authors.lastname: Cao
authors.forename: Yuan-Ning
authors.initials: YN
authors.lastname: Xu
authors.forename: Mao
authors.initials: M
authors.lastname: Chen
authors.forename: Yuan
authors.initials: Y
authors.lastname: Feng
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*