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Published on: February 2, 2021
Acute Kidney Injury Following Transcatheter Aortic Valve Implantation: Association with Contrast Media Dosage and
Doron Sudarsky1,2, Yarden Drutin2, Fabio Kusniec1,2
1The Department of Cardiology, The Lidya and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, B. Padeh Medical Center, Poriya 1528001, Israel.
Insights
Contrast media (CM) dose before and during transcatheter aortic valve implantation (TAVI) does not impact kidney function. Acute kidney injury (AKI) risk models incorporating CM may be limited, with baseline eGFR being the key predictor.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- The impact of contrast media (CM) on kidney function after transcatheter aortic valve implantation (TAVI) is unclear.
- Existing acute kidney injury (AKI) risk prediction models using CM may have questionable performance.
Purpose of the Study:
- To evaluate the association between CM dose and AKI post-TAVI.
- To assess the predictive value of CM-based AKI risk models in TAVI patients.
Main Methods:
- Retrospective study of 210 TAVI patients.
- Recorded CM dose (pre- and during TAVI) and calculated AKI risk scores.
- Assessed incidence of AKI and its correlation with CM dose and risk models.
Main Results:
- AKI occurred in 18.1% of patients.
- Lower baseline eGFR was observed in patients who developed AKI.
- CM dose did not differ between AKI+ and AKI- groups, but risk model scores were higher in AKI+ patients.
- Multivariable analysis identified only eGFR as an independent predictor of AKI.
Conclusions:
- CM dose administered before or during TAVI is not associated with post-procedural AKI.
- The predictive utility of CM-based AKI risk models in TAVI appears limited, primarily reflecting baseline eGFR.
Abstract:
The effect of contrast media (CM), delivered prior to- and during transcatheter aortic valve implantation (TAVI), on kidney function, following the procedure, is debatable. Consequently, the performance of CM-based, acute kidney injury (AKI) risk prediction models is also questionable. We retrospectively studied 210 patients that underwent TAVI. We recorded the dose of CM used prior and during TAVI, calculated the results of different AKI risk assessment models containing a CM module, and tested their association with AKI after the procedure. AKI was diagnosed in 38 patients (18.1%). The baseline estimated glomerular filtration rate (eGFR) was lower in the AKI+ group compared to AKI- group (51 ± 19.3 versus 64.5 ± 19 mL/min/1.73 mr2, respectively). While the dose of CM delivered prior to TAVI, during TAVI or the cumulative amount of both did not differ between the groups, the results of all tested risk models were higher in AKI+ patients. However, by multivariable analysis, only eGFR had a consistent independent association with AKI. We suggest that the dose of CM delivered prior or during TAVI is not associated with AKI and that the predictive power of CM based AKI risk models is, in all probability, limited to eGFR alone.
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