Comparison of acute kidney injury classifications in patients undergoing transcatheter aortic valve implantation: Predictors and long‐term outcomes
- 13 August 2015
- journal article
- valvular and-structural-heart-diseases
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 87 (3), 523-531
- https://doi.org/10.1002/ccd.26138
Abstract
Background Acute kidney injury (AKI) was demonstrated to adversely affect outcome in patients undergoing transcatheter aortic valve implantation (TAVI). We compared predictors for AKI and associated outcomes according to various definitions among patients undergoing TAVI in a tertiary medical center. Methods Two‐hundred and seventeen TAVI patients were evaluated for the occurrence of AKI according to Kidney Disease Improving Global Outcomes (KDIGO)/Valve Academic Research Consortium (VARC‐2) and Risk Injury Failure Loss End‐Stage (RIFLE) definitions. Multivariate analysis was conducted to assess predictors of AKI. Cox hazard ratio was used to evaluate long‐term mortality in this patient population. Results AKI occurred in 23 and 21% of patients (n = 49, n = 46) according to KDIGO/VARC‐2 and RIFLE definitions, respectively, with an approximate 10% of disagreement between both systems. Predictors of AKI according to KDIGO/VARC‐2 were chronic obstructive pulmonary disease (COPD; OR = 2.66, P = 0.01), PVD (OR = 3.45, P = 0.02) and a lower baseline eGFR (OR = 1.03 per 1 mL/min/1.73 m2 decrease, P = 0.02). While BMI (OR = 1.12, P = 0.01), prior ischemic heart disease (OR = 2.35, P = 0.04) and COPD (OR = 2.18, P = 0.04) were associated with AKI as defined by the RIFLE definition. AKI defined by either classification was independently associated with long‐term mortality (HR = 1.63, for the KDIGO/VARC‐2 definition and HR = 1.60 for RIFLE definition, P = 0.04 for both models), with borderline superiority of the KDIGO/VARC‐2 classification. Conclusions Different clinical characteristics predict the occurrence of AKI after TAVI when RIFLE and KDIGO/VARC‐2 classifications are used. Both classification systems of AKI identify patients with increased risk for long‐term mortality, with superiority of the KDIGO/VARC‐2 definition, which should be used for AKI grading.Keywords
This publication has 46 references indexed in Scilit:
- Incidence and Mortality of Acute Kidney Injury after Myocardial Infarction: A Comparison between KDIGO and RIFLE CriteriaPLOS ONE, 2013
- Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classificationCritical Care, 2013
- A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: Part 1: definitions, conservative management and contrast-induced nephropathyNephrology Dialysis Transplantation, 2012
- A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patientsCritical Care, 2012
- Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgeryCritical Care, 2011
- Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacementEuropean Heart Journal, 2009
- RIFLE is not RIFLE: on the comparability of resultsCritical Care, 2009
- The RIFLE criteria and mortality in acute kidney injury: A systematic reviewKidney International, 2008
- Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classificationsCritical Care, 2008
- Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injuryCritical Care, 2007