# Risk factors for acute kidney injury following transcatheter aortic valve replacement: a systematic review and meta-analysis

## TL;DR

This study identifies risk factors for kidney injury after a heart valve procedure, helping doctors better predict and manage patient risks.

## Contribution

The study provides a comprehensive meta-analysis of independent risk factors for acute kidney injury after TAVR.

## Key findings

- Eight independent predictors of AKI after TAVR were identified, including hypertension, CKD, and transapical access.
- Cardiovascular comorbidities and renal impairment were the main drivers of post-TAVR AKI.
- No publication bias was detected in the meta-analysis.

## Abstract

To delineate risk factors for acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) via a systematic review and meta-analysis.

PubMed, Embase, the Cochrane Library, and Web of Science were searched through February 2025 for case-control studies reporting post-TAVR AKI. Two reviewers independently performed study selection, data extraction, and bias assessment. Pooled analyses were conducted with Stata 15.0.

Thirty-four studies (10,353 patients) met the inclusion criteria; 2,250 patients (21.7%) developed AKI. Univariable meta-analysis implicated multiple comorbid, hemodynamic, and procedural factors [e.g., hypertension, diabetes, coronary and peripheral vascular disease, porcelain aorta, prior PCI, atrial fibrillation, chronic kidney disease (CKD), advanced NYHA class, left ventricular ejection fraction (LVEF) <40%, anemia, diuretic use, transapical/transaortic access, general anesthesia, rapid pacing, bleeding or vascular complications, transfusion, and peri-procedural myocardial infarction or stroke; all p < 0.05). Multivariable pooling isolated eight independent predictors: hypertension (OR 2.87), coronary artery disease (1.46), peripheral vascular disease (1.71), prior stroke (1.61), CKD (3.27), elevated serum creatinine (2.80), higher STS score (1.06 per point), and transapical access (3.45). Publication bias was not detected.

Post-TAVR AKI is chiefly driven by cardiovascular comorbidity and renal impairment, with hypertension, coronary and peripheral vascular disease, prior stroke, CKD, elevated creatinine, high STS score, and transapical access displaying the strongest, independent associations. Awareness of these factors may facilitate peri-procedural risk stratification and targeted renal-protective strategies.