• Łukasz Kalińczuk, Kamil Zieliński, Zbigniew Chmielak, Gary S Mintz, Maciej Dąbrowski, Ilona Kowalik, Mariusz Kłopotowski, Marcin Demkow, Tomasz Hryniewiecki, Ilona Michałowska, and Adam Witkowski.
• The Cardinal Stefan Wyszyński National Institute of Cardiology, Warsaw, Poland. lukasz.kalinczuk@gmail.com
• Pol. Arch. Med. Wewn. 2020 Oct 29; 130 (10): 844-852.

IntroductionChronic kidney disease (CKD) is frequent in patients treated with transcatheter aortic valve replacement. Yet, the procedure can improve kidney function, that is, it can lead to acute kidney recovery (AKR).ObjectivesThe aim of the study was to assess kidney function changes after transcatheter aortic valve replacement and their impact on long‑term outcomes.Patient And MethodsIn 432 patients (median age, 83 years; female sex, 63.4% ), estimated glomerular filtration rate (eGFR) was measured before and after the procedure. Chronic kidney disease was defined as a prior diagnosis or baseline eGFR of less than 60 ml/min/1.73 m2. Median (interquartile range [IQR]) follow‑up was 44.7 (31.2-48) months.ResultsOverall, 66.7% of patients had CKD. An increase in eGFR of 10% or greater at 48 hours (median [IQR], 39.8% [26.2%-51.8%]) was observed in 55.2% of patients with CKD and lasted until discharge (31.8% [17.8%-49%]) in 35.8% (the AKR group). In 17.4% of patients (64.3% with CKD), there was a drop in eGFR of 10% or greater at 48 hours, which remained at discharge in 6.5% of patients (the AKI group; median [IQR] eGFR drop, -22.8% [-40.6% to -14.9%] and -22.8% [-37.5% to -16.2%], respectively). There was a stepwise increase in AKR prevalence from CKD stage 1 and 2 (11.5%) to 4 (52%) (P = 0.03). In‑hospital mortality (P = 0.01) was highest with AKI (10.7%); intermediate with CKD but no AKR (6.6%); and lowest with neither CKD nor AKI (1.5%) or with AKR (1%). Estimated 4‑year mortality was correspondingly different (46.9%, 47.2%, 25.5%, 35.4%, respectively; P <0.001). The nonperipheral access was associated with more AKI and less AKR. Acute kidney recovery was more frequent with a history of stroke or transient ischemic attack or a newer generation self-expanding valves.ConclusionsTranscatheter aortic valve replacement led to acute kidney recovery in a substantial number of patients with CKD and an improved 4‑year survival.

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