Acute Kidney Injury After Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) has emerged as a safe and effective treatment option for patients with severe aortic stenosis (AS) who are too high risk for surgical valve replacement. Given the heavy burden of comorbidities associated with this population, there is much interest in identifying risk factors for adverse outcomes after TAVR, and one predictor that has repeatedly been identified is the development of acute kidney injury (AKI). Both patient-specific characteristics, such as age and baseline renal function, and intraprocedural factors, such as choice of access site, are associated with the development of AKI. Furthermore, patients who have advanced chronic kidney disease (CKD) or who develop a new dialysis requirement after TAVR are at particularly high risk of adverse events. Newer methods of identifying patients at risk of developing AKI, such as metabolite profiling, show a promise for improved pre-procedural risk stratification over traditional clinical factors. With an aging population and expanding indications for use, the number of patients receiving TAVR is expected to grow. Further investigations into identifying modifiable risk factors and strategies to limit post-TAVR AKI are needed.