Related Experiment Video
Updated: Dec 13, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Improvement in long-term survival with acute kidney recovery after a successful transcatheter aortic valve
Łukasz Kalińczuk1, Kamil Zieliński2,3, Zbigniew Chmielak2
1The Cardinal Stefan Wyszyński National Institute of Cardiology, Warsaw, Poland. lukasz.kalinczuk@gmail.com
Insights
Transcatheter aortic valve replacement can improve kidney function in many patients with chronic kidney disease (CKD), leading to acute kidney recovery (AKR) and better long-term survival.
Area of Science:
- Cardiology
- Nephrology
- Medical Devices
Background:
- Chronic kidney disease (CKD) is common in patients undergoing transcatheter aortic valve replacement (TAVR).
- TAVR procedures can paradoxically improve kidney function, termed acute kidney recovery (AKR).
Purpose of the Study:
- To evaluate changes in kidney function post-TAVR.
- To determine the impact of these changes on long-term patient outcomes.
Main Methods:
- Assessed estimated glomerular filtration rate (eGFR) in 432 patients before and after TAVR.
- Defined CKD as prior diagnosis or baseline eGFR < 60 ml/min/1.73 m².
- Followed patients for a median of 44.7 months.
Main Results:
- 66.7% of patients had CKD; 55.2% with CKD experienced AKR (≥10% eGFR increase at 48 hours).
- Acute kidney injury (AKI) occurred in 17.4% of patients.
- AKR was associated with significantly lower 4-year mortality (25.5%) compared to no AKR (46.9%) or AKI (47.2%).
Conclusions:
- TAVR can induce AKR in a significant proportion of CKD patients.
- Achieving AKR after TAVR is linked to improved long-term survival.
Introduction:
Chronic kidney disease (CKD) is frequent in patients treated with transcatheter aortic valve replacement. Yet, the procedure can improve kidney function, that is, it can lead to acute kidney recovery (AKR).
Objectives:
The aim of the study was to assess kidney function changes after transcatheter aortic valve replacement and their impact on long‑term outcomes.
Patient And Methods:
In 432 patients (median age, 83 years; female sex, 63.4% ), estimated glomerular filtration rate (eGFR) was measured before and after the procedure. Chronic kidney disease was defined as a prior diagnosis or baseline eGFR of less than 60 ml/min/1.73 m2. Median (interquartile range [IQR]) follow‑up was 44.7 (31.2-48) months.
Results:
Overall, 66.7% of patients had CKD. An increase in eGFR of 10% or greater at 48 hours (median [IQR], 39.8% [26.2%-51.8%]) was observed in 55.2% of patients with CKD and lasted until discharge (31.8% [17.8%-49%]) in 35.8% (the AKR group). In 17.4% of patients (64.3% with CKD), there was a drop in eGFR of 10% or greater at 48 hours, which remained at discharge in 6.5% of patients (the AKI group; median [IQR] eGFR drop, -22.8% [-40.6% to -14.9%] and -22.8% [-37.5% to -16.2%], respectively). There was a stepwise increase in AKR prevalence from CKD stage 1 and 2 (11.5%) to 4 (52%) (P = 0.03). In‑hospital mortality (P = 0.01) was highest with AKI (10.7%); intermediate with CKD but no AKR (6.6%); and lowest with neither CKD nor AKI (1.5%) or with AKR (1%). Estimated 4‑year mortality was correspondingly different (46.9%, 47.2%, 25.5%, 35.4%, respectively; P <0.001). The nonperipheral access was associated with more AKI and less AKR. Acute kidney recovery was more frequent with a history of stroke or transient ischemic attack or a newer generation self-expanding valves.
Conclusions:
Transcatheter aortic valve replacement led to acute kidney recovery in a substantial number of patients with CKD and an improved 4‑year survival.
Related Concept Videos
01:25Aortic Regurgitation III: Medical Management
01:28Kidney Transplant I: Introduction
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention