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首页> 外文期刊>Catheterization and cardiovascular interventions: Official journal of the Society for Cardiac Angiography & Interventions >Interaction between severe chronic kidney disease and acute kidney injury in predicting mortality after transcatheter aortic valve implantation: Insights from the Italian Clinical Service Project
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Interaction between severe chronic kidney disease and acute kidney injury in predicting mortality after transcatheter aortic valve implantation: Insights from the Italian Clinical Service Project

机译：经经管主动脉瓣植入经经慢性肾疾病和急性肾损伤预测性能临床服务项目的相互作用：意大利临床服务项目见解

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Aims We aim at exploring whether severe chronic kidney disease (CKD) may modify the impact of acute kidney injury (AKI) post-transcatheter aortic valve implantation (TAVI) on early, mid, and long-term mortality. Methods and results The analysis included 2,733 TAVI patients from the Italian Clinical Service Project. The population was stratified in four groups according to the presence of baseline severe CKD and postprocedural AKI. All-cause mortality was the primary end point. Postprocedural AKI is associated with an increased risk of early and mid-term mortality after TAVI regardless of baseline severe CKD. Preprocedural severe CKD is associated with an increased risk of long-term mortality after TAVI regardless of postprocedural AKI. No interaction between preprocedural severe CKD and postprocedural AKI was observed in predicting mortality at both 30-day (CKD: hazard ratio [HR] = 2.65, 95% confidence interval [CI] = 1.15-6.12; no-CKD: HR = 3.83, 95% CI = 2.23-6.58;P-int= 0.129) and 1-year (CKD: HR = 2.29, 95% CI = 1.37-3.82; no-CKD: HR = 2.47, 95% CI = 1.75-3.49;P-int= 0.386). Preprocedural severe CKD is an independent predictor of postprocedural AKI (HR = 2.17, 95% CI = 1.56-3.03;p< .001) as well as general anesthesia and access alternative to femoral. Among no-AKI patients, those with severe CKD at admission underwent kidney function recovery after TAVI (serum creatinine at baseline 2.24 +/- 1.57 mg/dL and at 48-hr 1.80 +/- 1.17 mg/dL;p= .003). Conclusions Preprocedural severe CKD did not modify the impact of postprocedural AKI in predicting early and mid-term mortality after TAVI. Closely monitoring of serum creatinine and strategies to prevent AKI post-TAVI are needed also in patients without severe CKD at admission.
机译：目的：我们旨在探讨严重慢性肾病（CKD）是否可能改变经导管主动脉瓣植入术（TAVI）后急性肾损伤（AKI）对早期、中期和长期死亡率的影响。方法和结果分析包括2733名来自意大利临床服务项目的TAVI患者。根据基线严重CKD和术后AKI的存在情况，将人群分为四组。全因死亡率是主要终点。术后AKI与TAVI术后早期和中期死亡率的增加相关，而与基线严重CKD无关。无论术后AKI如何，术前重度CKD与TAVI术后长期死亡风险增加相关。在预测30天（CKD：危险比[HR]=2.65，95%可信区间[CI]=1.15-6.12；无CKD:HR=3.83，95%可信区间=2.23-6.58；P-int=0.129）和1年（CKD:HR=2.29，95%可信区间=1.37-3.82；无CKD:HR=2.47，95%可信区间=1.75-3.49；P-int=0.386）的死亡率方面，未观察到术前重度CKD与术后AKI之间的相互作用。术前重度CKD是术后AKI（HR=2.17，95%CI=1.56-3.03；p<0.001）以及全身麻醉和股动脉旁路的独立预测因子。在无AKI患者中，入院时患有严重CKD的患者在TAVI后肾功能恢复（基线时血清肌酐为2.24+/-1.57 mg/dL，48小时时为1.80+/-1.17 mg/dL；p=0.003）。结论术前重度CKD并不影响术后AKI对TAVI术后早期和中期死亡率的预测。入院时无严重CKD的患者也需要密切监测血清肌酐和预防TAVI后AKI的策略。

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