Abstract 19726: Circulating Metabolites Predict Acute Kidney Injury After Transcatheter Aortic Valve Replacement

Introduction: Acute kidney injury (AKI) occurs commonly after transcatheter aortic valve replacement (TAVR) and is associated with increased perioperative morbidity and mortality. Previously, we identified circulating metabolites associated with renal function and predictive of incident chronic kidney disease (CKD). Hypothesis: We hypothesize that these previously identified metabolites will predict AKI after TAVR. Methods: We performed liquid chromatography-mass spectrometry-based metabolite profiling on plasma obtained from patients prior to TAVR. AKI was defined using the Valve Academic Research Consortium-2 criteria. Twelve metabolites that reflect renal function were chosen a prior for this analysis. Results: Of 304 patients (51% female, mean age 82±9 yrs), 38 (13%) developed AKI after TAVR. Patients who developed AKI had a higher baseline creatinine and prevalence of coronary disease and atrial fibrillation (P≤0.01 for all), but similar glomerular filtration rate (GFR; P=0.20). Among the 12 metabolites of interest, 11 significantly correlated with baseline GFR and were differentially detected in those with and without CKD. Before and after adjustment for GFR, age, sex, and diabetes, baseline levels of kynurenic acid, xanthosine, and trimethylamine-N-oxide (TMNO) were predictive of AKI (Table). A metabolic multimarker score based on these 3 circulating metabolites was predictive of AKI (odds ratio of 3 rd vs. 1 st tertile: 3.58, 95% CI 1.52-8.44, P=0.002). Incident AKI was 7.5%, 10.7%, and 22.5%, respectively, for increasing tertiles of the multimarker score (P=0.006). Conclusions: In elderly patients undergoing TAVR for aortic stenosis, circulating metabolites identify those at highest risk of AKI. Given the serious adverse consequences of AKI, strategies to prevent AKI may be particularly important to test and implement in this high-risk sub-group of patients.