TY - JOUR
T1 - Interaction between severe chronic kidney disease and acute kidney injury in predicting mortality after transcatheter aortic valve implantation
T2 - Insights from the Italian Clinical Service Project
AU - Adamo, Marianna
AU - Provini, Martino
AU - Fiorina, Claudia
AU - Giannini, Cristina
AU - Angelillis, Marco
AU - Testa, Luca
AU - Barbanti, Marco
AU - Merlanti, Bruno
AU - Poli, Arnaldo
AU - Ferrara, Erica
AU - Latib, Azeem
AU - Reimers, Bernhard
AU - Maffeo, Diego
AU - Bruschi, Giuseppe
AU - Montorfano, Matteo
AU - Petronio, Anna Sonia
AU - Bedogni, Francesco
AU - Tamburino, Corrado
AU - Metra, Marco
AU - Curello, Salvatore
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC.
PY - 2020/12
Y1 - 2020/12
N2 - Aims: We aim at exploring whether severe chronic kidney disease (CKD) may modify the impact of acute kidney injury (AKI) post-transcatheter aortic valve implantation (TAVI) on early, mid, and long-term mortality. Methods and results: The analysis included 2,733 TAVI patients from the Italian Clinical Service Project. The population was stratified in four groups according to the presence of baseline severe CKD and postprocedural AKI. All-cause mortality was the primary end point. Postprocedural AKI is associated with an increased risk of early and mid-term mortality after TAVI regardless of baseline severe CKD. Preprocedural severe CKD is associated with an increased risk of long-term mortality after TAVI regardless of postprocedural AKI. No interaction between preprocedural severe CKD and postprocedural AKI was observed in predicting mortality at both 30-day (CKD: hazard ratio [HR] = 2.65, 95% confidence interval [CI] = 1.15–6.12; no-CKD: HR = 3.83, 95% CI = 2.23–6.58; Pint =.129) and 1-year (CKD: HR = 2.29, 95% CI = 1.37–3.82; no-CKD: HR = 2.47, 95% CI = 1.75–3.49; Pint =.386). Preprocedural severe CKD is an independent predictor of postprocedural AKI (HR = 2.17, 95% CI = 1.56–3.03; p <.001) as well as general anesthesia and access alternative to femoral. Among no-AKI patients, those with severe CKD at admission underwent kidney function recovery after TAVI (serum creatinine at baseline 2.24 ± 1.57 mg/dL and at 48-hr 1.80 ± 1.17 mg/dL; p =.003). Conclusions: Preprocedural severe CKD did not modify the impact of postprocedural AKI in predicting early and mid-term mortality after TAVI. Closely monitoring of serum creatinine and strategies to prevent AKI post-TAVI are needed also in patients without severe CKD at admission.
AB - Aims: We aim at exploring whether severe chronic kidney disease (CKD) may modify the impact of acute kidney injury (AKI) post-transcatheter aortic valve implantation (TAVI) on early, mid, and long-term mortality. Methods and results: The analysis included 2,733 TAVI patients from the Italian Clinical Service Project. The population was stratified in four groups according to the presence of baseline severe CKD and postprocedural AKI. All-cause mortality was the primary end point. Postprocedural AKI is associated with an increased risk of early and mid-term mortality after TAVI regardless of baseline severe CKD. Preprocedural severe CKD is associated with an increased risk of long-term mortality after TAVI regardless of postprocedural AKI. No interaction between preprocedural severe CKD and postprocedural AKI was observed in predicting mortality at both 30-day (CKD: hazard ratio [HR] = 2.65, 95% confidence interval [CI] = 1.15–6.12; no-CKD: HR = 3.83, 95% CI = 2.23–6.58; Pint =.129) and 1-year (CKD: HR = 2.29, 95% CI = 1.37–3.82; no-CKD: HR = 2.47, 95% CI = 1.75–3.49; Pint =.386). Preprocedural severe CKD is an independent predictor of postprocedural AKI (HR = 2.17, 95% CI = 1.56–3.03; p <.001) as well as general anesthesia and access alternative to femoral. Among no-AKI patients, those with severe CKD at admission underwent kidney function recovery after TAVI (serum creatinine at baseline 2.24 ± 1.57 mg/dL and at 48-hr 1.80 ± 1.17 mg/dL; p =.003). Conclusions: Preprocedural severe CKD did not modify the impact of postprocedural AKI in predicting early and mid-term mortality after TAVI. Closely monitoring of serum creatinine and strategies to prevent AKI post-TAVI are needed also in patients without severe CKD at admission.
KW - Acute kidney injury
KW - Chronic kidney disease
KW - Transcatheter aortic valve implantation
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U2 - 10.1002/ccd.28927
DO - 10.1002/ccd.28927
M3 - Article
C2 - 32644300
AN - SCOPUS:85087719654
SN - 1522-1946
VL - 96
SP - 1500
EP - 1508
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 7
ER -