Acute kidney injury following aortic valve replacement in
patients without chronic kidney disease
Moriyama , N , Laakso , T , Raivio , P , Dahlbacka , S , Kinnunen , E-M , Juvonen , T ,
Valtola , A , Husso , A , Jalava , M P , Ahvenvaara , T , Tauriainen , T , Piuhola , J , Lahtinen
, A , Niemelä , M , Mäkikallio , T , Virtanen , M , Maaranen , P , Eskola , M , Savontaus , M ,
Airaksinen , J , Biancari , F & Laine , M 2021 , ' Acute kidney injury following aortic valve
replacement in patients without chronic kidney disease ' , Canadian Journal of Cardiology ,
vol. 37 , no. 1 , pp. 37-46 . https://doi.org/10.1016/j.cjca.2020.03.015
Downloaded from Helda, University of Helsinki institutional repository.
This is an electronic reprint of the original article.
This reprint may differ from the original in pagination and typographic detail.
Please cite the original version.
Acute kidney injury following aortic valve replacement in patients without chronic
Noriaki Moriyama, MD, Teemu Laakso, MD, Peter Raivio, MD, PhD, Sebastian
Dahlbacka, MD, PhD, Eeva-Maija Kinnunen, MD, PhD, Tatu Juvonen, MD, PhD, Antti
Valtola, MD, Annastiina Husso, MD, PhD, Maina P. Jalava, MD, Tuomas Ahvenvaara,
MD, Tuomas Tauriainen, MD, PhD, Jarkko Piuhola, MD, PhD, Asta Lahtinen, MD,
Matti Niemelä, MD, PhD, Timo Mäkikallio, MD, PhD, Marko Virtanen, MD, Pasi
Maaranen, MD, Markku Eskola, MD, PhD, Mikko Savontaus, MD, PhD, Juhani
Airaksinen, MD, PhD, Fausto Biancari, MD, PhD, Mika Laine, MD, PhD
Reference: CJCA 3670
To appear in:
Canadian Journal of Cardiology
Received Date: 16 January 2020
Revised Date: 25 February 2020
Accepted Date: 14 March 2020
Please cite this article as: Moriyama N, Laakso T, Raivio P, Dahlbacka S, Kinnunen E-M, Juvonen
T, Valtola A, Husso A, Jalava MP, Ahvenvaara T, Tauriainen T, Piuhola J, Lahtinen A, Niemelä M,
Mäkikallio T, Virtanen M, Maaranen P, Eskola M, Savontaus M, Airaksinen J, Biancari F, Laine M, Acute
kidney injury following aortic valve replacement in patients without chronic kidney disease, Canadian
Journal of Cardiology (2020), doi: https://doi.org/10.1016/j.cjca.2020.03.015.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition
of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of
record. This version will undergo additional copyediting, typesetting and review before it is published
in its final form, but we are providing this version to give early visibility of the article. Please note that,
during the production process, errors may be discovered which could affect the content, and all legal
disclaimers that apply to the journal pertain.
© 2020 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
Acute kidney injury following aortic valve replacement in patients without
chronic kidney disease
MD; Teemu Laakso,
MD; Peter Raivio,
MD, PhD; Sebastian Dahlbacka,
PhD; Eeva-Maija Kinnunen,
MD, PhD; Tatu Juvonen,
MD, PhD; Antti Valtola,
MD, PhD; Maina P. Jalava,
MD; Tuomas Ahvenvaara,
MD; Tuomas Tauriainen,
MD, PhD; Asta Lahtinen,
MD; Matti Niemelä,
MD, PhD; Timo Mäkikallio,
PhD; Marko Virtanen,
MD; Pasi Maaranen,
MD; Markku Eskola,
MD, PhD; Mikko Savontaus,
PhD; Juhani Airaksinen,
MD, PhD; Fausto Biancari,
MD, PhD; Mika Laine,
Heart and Lung Center, Helsinki University Hospital, Helsinki;
Heart Center, Kuopio University
Heart Center, Turku University Hospital and University of Turku, Turku;
Department of Surgery, Oulu University Hospital and University of Oulu, Oulu;
Internal Medicine, Oulu University Hospital, Oulu;
Heart Hospital, Tampere University Hospital and
University of Tampere, Tampere, Finland.
Short title: AKI in patients without CKD following TAVR and SAVR
Word counts: 5497
Address for correspondence:
Mika Laine, MD, PhD, Adjunct Professor of Cardiology
Heart and Lung Center, Helsinki University and Helsinki University Central Hospital,
Haartmaninkatu 4, 00290, Helsinki, Finland.
Telephone: +358504279008, Fax: +358504270352, E-mail: Mika.Laine@hus.fi
Backgrounds: The data on acute kidney injury (AKI) in patients without chronic kidney disease
(CKD) after transcatheter aortic valve replacement (TAVR) are limited. The study sought to compare
the incidence of AKI and its impact on 5-year mortality following TAVR and surgical aortic valve
replacement (SAVR) in patients without CKD.
Methods: This registry included data from 6463 consecutive patients who underwent TAVR or SAVR.
CKD was defined as estimated glomerular filtration rate (eGFR)<60 ml/min/1.73m
. AKI was defined
according to the Kidney Disease Improving Global Outcomes criteria. For sensitivity analysis,
propensity-score (PS) matching between TAVR and SAVR was performed.
Results: The study included 4555 consecutive patients (TAVR, n=1215 and SAVR, n=3340) without
CKD. PS matching identified 542 pairs. Patients who underwent TAVR had a significantly lower
incidence of AKI in comparison to those who underwent SAVR (unmatched 4.7% vs 16.4%, P<0.001,
multivariable analysis: OR 0.29, 95% CI 0.20-0.41; matched 5.9% vs 19.0%, P<0.001). Patients with
AKI had significantly increased 5-year mortality compared to those without AKI (unmatched 36.0%
vs 19.1%, log-rank P<0.001; matched 36.3% vs 24.0%, log-rank P<0.001). The adjusted hazard ratios
for 5-year mortality were 1.58 (95%CI 1.20-2.08) for AKI grade 1, 3.27 (95%CI 2.09-5.06) for grade 2
and 4.82 (95%CI 2.93-8.04) for grade 3.
Conclusions: TAVR in patients without CKD was associated with significantly less frequent
incidence of AKI compared with SAVR. AKI significantly increased the risk of 5-year mortality after
either TAVR or SAVR and increasing severity of AKI was incrementally associated with 5-year
Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT03385915.