Impact of procedure-related increase in plasma creatinine after transcatheter aortic valve implantation: a nationwide study

Background In patients undergoing transcatheter aortic valve implantation (TAVI), the impact of plasma creatinine (PCreat) increase on the prognosis and on future kidney function is sparsely examined and data from large, nationwide cohorts are warranted. Purpose To examine the long-term risk of dialysis treatment, mortality, and major adverse kidney event according to PCreat level increments in the periprocedural setting of TAVI. Methods With Danish nationwide registries, we identified all patients undergoing TAVI from 2014–2021. According to two PCreat blood samples (the latest measured value between 365–7 days prior to TAVI and the highest measured value within 21 days after TAVI), patients were classified according to percent increase in PCreat: 1) <25%, 2) 25–49%, and 3) ≥50%. With a maximum of one year of follow-up, we used Aalen-Johanson estimator to examine the cumulative incidence frequency (CIF) of first-time dialysis treatment and major adverse kidney event and Kaplan-Meier estimates to assess all-cause mortality. Major adverse kidney event was defined as either of three: initiation of dialysis treatment, mortality, or an admission with a diagnosis code of acute kidney injury. Adjusted rates of outcomes were assessed, using multivariable Cox analysis, with patients with <25% PCreat increase serving as reference. Results We identified 4,029 patients undergoing a first-time TAVI procedure (57.0% male, median age 81 year); 3,343 (83.0%) patients with <25% PCreat increase, 462 (11.5%) with 25–49% PCreat increase, and 224 (5.6%) with ≥50% PCreat increase. Compared with <25% PCreat increase, the adjusted one-year rate of dialysis treatment showed no statistical difference in patients with 25-49% PCreat increase (hazard ratio [HR] 1.52 [95%CI, 0.74–3.11]), while patients with ≥50% PCreat increase had an increased associated one-year rate of dialysis treatment (HR 3.62 [95%CI, 1.90–6.90]) (Figure). The adjusted one-year rate of mortality was increased in both patients with 25-49% PCreat increase (HR 1.78 [95%CI, 1.29–2.45]) and ≥50% PCreat increase (HR 2.87 [95%CI, 1.97–4.18]). The adjusted one-year rate of major adverse kidney event was increased in both patients with 25-49% PCreat increase (HR 1.69 [95%CI, 1.25–2.28]) and ≥50% PCreat increase (HR 3.03 [95%CI, 2.17–4.23]). Conclusion In patients undergoing TAVI, a PCreat increase of ≥25% was associated with increased one-year rates of mortality and major adverse kidney event, while an increase ≥50% carried a more than threefold increased rate of incident dialysis treatment and increased rates of mortality and major adverse kidney event.