Original title: Renal Function-Based Contrast Dosing Predicts Acute Kidney Following Trancatheter Aortic Valve Implantation Reference: Masanori Yamamoto, et al. J Am Coll Cardiol Intv 2013;6:479–86.
Acute kidney injury (AKI) presents in 10 to 30% of patients undergoing TAVI; it is associated to the increase of morbidity and mortality and it prolongues hospitalization. This study included 415 patients with severe aortic stenosis that received the Edwards Valve or the CoreValve.
Renal function was estimated using the glomerular filtration rate (eGFR) value, and contrast media dosing (CM) was determined with the formula that calculates CM volume to serum creatinine (SCr) and body weight (BW) (CM × SCr/BW). 63 patients (15.2%) presented acute kidney injury (AKI), and 59 of them (93.7%) were categorized as grade 2.
AKI patients had a significantly lower eGRF, lower ejection fraction and higher aortic regurgitation degree. CM dosing was also higher. Mortality at 30 days was significantly higher among AKI patients (15.9% vs. 4.1%; p<0.001) as well as mortality at 12 months (47.9% vs. 15.7%; p<0.001). Vascular complications and transfusion rates were also higher in the AKI group. The cut-off point that predicts kidney failure in the formula that associates CM volume, creatinine and body weight is 2.7.
Conclusion:
Even though the mechanism that produces post TAVI kidney injury is multifactorial, this study identified the relationship between CM dosing and the prevalence of AKI.
Comment:
Post TAVI AKI is multifactorial, especially in this group of patients. One of the factors to be considered is the risk of procedural hypotension, especially at the moment of valvuloplasty, since it could prolong and impact at kidney level, adding to CM impact. This study has given us the tools to assess renal impact and take the necessary steps to reduce the risk of AKI.
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