Purpose <p>Acute kidney injury (AKI) is a common complication and a strong risk factor for adverse outcomes after transcatheter aortic valve implantation (TAVI). Renal regional tissue oxygen saturation (rSO₂) reflects tissue perfusion and can be measured using near-infrared spectroscopy. We hypothesized that decrease in renal rSO₂ during TAVI would predict post-procedural AKI.</p> Methods <p>Patients with severe aortic stenosis who scheduled for transfemoral TAVI were enrolled. Patients undergoing emergent procedures, those with severe renal impairment, those with a distance from skin to renal capsule &gt; 4&#xa0;cm, those on mechanical ventilation, or those who refused to participate were excluded. The primary outcome was the relationship between changes in renal rSO₂ during TAVI and post-procedural AKI. AKI was determined according to the Valve Academic Research Consortium-2 criteria.</p> Results <p>Sixty-four patients were included and analyzed. The mean (standard deviation [SD]) age of patients was 82 (4) years, and the median [interquartile range] procedure time was 75 [65–90] min. The incidence of post-procedural AKI was 33% (21/64). There was no difference in the mean (SD) time-weighted renal rSO₂ (70% [13%] and 73% [11%]), changes in renal rSO₂ (–14% [10%] and − 15% [13%]), or nadir rSO₂ (55% [17%] and 60% [17%]) during TAVI between patients who developed post-TAVI AKI and those who did not (<i>p</i> = 0.227, 0.157, and 0.333, respectively). In multivariable regression analysis, renal rSO₂ variables were not predictors of post-TAVI AKI.</p> Conclusion <p>Procedural changes in renal rSO₂ measured using near-infrared spectroscopy did not predict the development of post-TAVI AKI. Further studies are needed to investigate more effective strategies to predict and prevent AKI following TAVI.</p> Trial registration <p>This study was registered on cinicaltrials.gov (identifier, NCT04921475, registered on June 10, 2021).</p>