December 28, 2017
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Acute kidney recovery after TAVR more common in men than women

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In patients who underwent transcatheter aortic valve replacement, male sex, chronic kidney disease and nonuse of beta-blockers were predictors of acute kidney recovery after the procedure, according to a study published in The American Journal of Cardiology.

Amir Azarbal, MD, cardiovascular disease fellow at Larner College of Medicine at the University of Vermont in Burlington, and colleagues analyzed data from 366 patients (mean age, 80 years; 50% men) with severe symptomatic aortic stenosis who underwent TAVR from 2012 to 2016. Renal function assessments were completed 48 hours after TAVR. Information such as baseline data, preprocedural medications, image data and follow-up laboratory results were reviewed.

Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. Acute kidney recovery was an eGFR improvement of 25% at 48 hours after TAVR. Acute kidney injury with a creatinine increase was defined as an elevation of at least 0.3 mg/dL at 48 hours after the procedure.

Patients were categorized into three groups: acute kidney recovery, unchanged eGFR and acute kidney injury with a decrease in eGFR.

One-third of patients had acute kidney recovery, and three-quarters of those with acute kidney recovery or injury had chronic kidney disease.

Acute kidney injury with a creatinine increase occurred in 13.4% of patients, and 14.7% developed acute kidney injury with a decrease in eGFR.

Acute kidney recovery was more likely to occur in patients with baseline chronic kidney disease (OR = 1.04; 95% CI, 1.31-3.67). Negative predictors of acute kidney recovery included female sex (OR = 0.44; 95% CI, 0.27-0.71) and the use of beta-blockers before the procedure (OR = 0.49; 95% CI, 0.3-0.82). Contrast volume and left ventricular dysfunction were not predictors of acute kidney recovery.

Patients who had acute kidney recovery were less likely to have a transfusion (11%) vs. those with acute kidney injury (26%; P = .03). No patients from the recovery group died compared with 9.3% in the injury group (P < .001).

“While the interaction between baseline renal dysfunction and [acute kidney recovery] is expected, the association between beta-blockade and female sex with [acute kidney recovery] requires further study,” Azarbal and colleagues wrote. “While our study demonstrates an in-hospital difference in morality and transfusions based upon dynamic changes in kidney function after TAVI, the association between [acute kidney recovery] with persistent renal recovery and improved long-term outcomes remains to be established.” – by Darlene Dobkowski

Disclosure: The authors report no relevant financial disclosures.