Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement
Abstract Background Acute kidney injury after cardiac surgery significantly associates with morbidity and mortality. Despite not requiring cardiopulmonary bypass, transcatheter aortic valve replacement patients have an incidence of post-procedural acute kidney injury similar to patients who undergo...
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doaj-154fb29115c24f1e93750b8538bee48c2020-11-25T03:17:08ZengBMCBMC Anesthesiology1471-22532019-06-0119111010.1186/s12871-019-0764-0Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacementAkeel M. Merchant0Javier A. Neyra1Abu Minhajuddin2Lauren E. Wehrmann3Richard A. Mills4Sarah K. Gualano5Dharam J. Kumbhani6Lynn C. Huffman7Michael E. Jessen8Amanda A. Fox9Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical CenterCharles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical CenterDepartment of Population and Data Sciences, University of Texas Southwestern Medical CenterDepartment of Anesthesiology and Pain Management, University of Texas Southwestern Medical CenterDepartment of Internal Medicine, University of Texas Southwestern Medical CenterDepartment of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical CenterDepartment of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical CenterDepartment of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical CenterDepartment of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical CenterDepartment of Anesthesiology and Pain Management, University of Texas Southwestern Medical CenterAbstract Background Acute kidney injury after cardiac surgery significantly associates with morbidity and mortality. Despite not requiring cardiopulmonary bypass, transcatheter aortic valve replacement patients have an incidence of post-procedural acute kidney injury similar to patients who undergo open surgical aortic valve replacement. Packed red blood cell transfusion has been associated with morbidity and mortality after cardiac surgery. We hypothesized that packed red blood cell transfusion independently associates with acute kidney injury after transcatheter aortic valve replacement, after accounting for other risk factors. Methods This is a single-center retrospective cohort study of 116 patients undergoing transcatheter aortic valve replacement. Post-transcatheter aortic valve replacement acute kidney injury was defined by Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Univariate comparisons between patients with and without post-transcatheter aortic valve replacement acute kidney injury were made for clinical characteristics. Multivariable logistic regression was used to assess independent association of packed red blood cell transfusion with post-transcatheter aortic valve replacement acute kidney injury (adjusting for pre-procedural renal function and other important clinical parameters). Results Acute kidney injury occurred in 20 (17.2%) subjects. Total number of packed red blood cells transfused independently associated with post-procedure acute kidney injury (OR = 1.67 per unit, 95% CI 1.13–2.47, P = 0.01) after adjusting for pre-procedure estimated glomerular filtration rate (OR = 0.97 per ml/min/1.73m2, 95% CI 0.94–1.00, P = 0.05), nadir hemoglobin (OR = 0.88 per g/dL increase, CI 0.61–1.27, P = 0.50), and post-procedure maximum number of concurrent inotropes and vasopressors (OR = 2.09 per inotrope or vasopressor, 95% CI 1.19–3.67, P = 0.01). Conclusion Packed red blood cell transfusion, along with post-procedure use of inotropes and vasopressors, independently associate with acute kidney injury after transcatheter aortic valve replacement. Further studies are needed to elucidate the pathobiology underlying these associations.http://link.springer.com/article/10.1186/s12871-019-0764-0Blood cell transfusionAcute kidney injuryTranscatheter aortic valve replacementVasoconstrictor agentsAnemia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Akeel M. Merchant Javier A. Neyra Abu Minhajuddin Lauren E. Wehrmann Richard A. Mills Sarah K. Gualano Dharam J. Kumbhani Lynn C. Huffman Michael E. Jessen Amanda A. Fox |
spellingShingle |
Akeel M. Merchant Javier A. Neyra Abu Minhajuddin Lauren E. Wehrmann Richard A. Mills Sarah K. Gualano Dharam J. Kumbhani Lynn C. Huffman Michael E. Jessen Amanda A. Fox Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement BMC Anesthesiology Blood cell transfusion Acute kidney injury Transcatheter aortic valve replacement Vasoconstrictor agents Anemia |
author_facet |
Akeel M. Merchant Javier A. Neyra Abu Minhajuddin Lauren E. Wehrmann Richard A. Mills Sarah K. Gualano Dharam J. Kumbhani Lynn C. Huffman Michael E. Jessen Amanda A. Fox |
author_sort |
Akeel M. Merchant |
title |
Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement |
title_short |
Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement |
title_full |
Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement |
title_fullStr |
Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement |
title_full_unstemmed |
Packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement |
title_sort |
packed red blood cell transfusion associates with acute kidney injury after transcatheter aortic valve replacement |
publisher |
BMC |
series |
BMC Anesthesiology |
issn |
1471-2253 |
publishDate |
2019-06-01 |
description |
Abstract Background Acute kidney injury after cardiac surgery significantly associates with morbidity and mortality. Despite not requiring cardiopulmonary bypass, transcatheter aortic valve replacement patients have an incidence of post-procedural acute kidney injury similar to patients who undergo open surgical aortic valve replacement. Packed red blood cell transfusion has been associated with morbidity and mortality after cardiac surgery. We hypothesized that packed red blood cell transfusion independently associates with acute kidney injury after transcatheter aortic valve replacement, after accounting for other risk factors. Methods This is a single-center retrospective cohort study of 116 patients undergoing transcatheter aortic valve replacement. Post-transcatheter aortic valve replacement acute kidney injury was defined by Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Univariate comparisons between patients with and without post-transcatheter aortic valve replacement acute kidney injury were made for clinical characteristics. Multivariable logistic regression was used to assess independent association of packed red blood cell transfusion with post-transcatheter aortic valve replacement acute kidney injury (adjusting for pre-procedural renal function and other important clinical parameters). Results Acute kidney injury occurred in 20 (17.2%) subjects. Total number of packed red blood cells transfused independently associated with post-procedure acute kidney injury (OR = 1.67 per unit, 95% CI 1.13–2.47, P = 0.01) after adjusting for pre-procedure estimated glomerular filtration rate (OR = 0.97 per ml/min/1.73m2, 95% CI 0.94–1.00, P = 0.05), nadir hemoglobin (OR = 0.88 per g/dL increase, CI 0.61–1.27, P = 0.50), and post-procedure maximum number of concurrent inotropes and vasopressors (OR = 2.09 per inotrope or vasopressor, 95% CI 1.19–3.67, P = 0.01). Conclusion Packed red blood cell transfusion, along with post-procedure use of inotropes and vasopressors, independently associate with acute kidney injury after transcatheter aortic valve replacement. Further studies are needed to elucidate the pathobiology underlying these associations. |
topic |
Blood cell transfusion Acute kidney injury Transcatheter aortic valve replacement Vasoconstrictor agents Anemia |
url |
http://link.springer.com/article/10.1186/s12871-019-0764-0 |
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