Endovascular treatment of complex aortic aneurysms: prevalence of acute kidney injury and effect on long-term renal function

Sailer, Anna M.; Nelemans, Patricia J.; Berlo, Camille van; Yazar, Ozan; Haan, Michiel W. de; Fleischmann, Dominik; Schurink, Geert Willem H.

doi:10.1007/s00330-015-3993-8

Cited by 41 publications

(31 citation statements)

References 28 publications

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“…The incidence of AKI was 18% in our study, which is consistent with that of previous studies (19%-29%) (7,18). Incidence may vary across studies for various reasons, one of them being the difference in classification of AKI.…”

Section: Discussionsupporting

confidence: 92%

Complications of Endovascular Aneurysm Repair: Mortality, Myocardial Infarction and Acute Kidney Injury

Reis¹,

Morgado²,

Valdoleiros³

et al. 2018

Turk J Anaesth Reanim

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Objective: Patients undergoing endovascular aneurysm repair (EVAR) have comorbidities that increase the risk of death, myocardial infarction (MI) and acute kidney injury (AKI). Our aim was to evaluate the incidence and predictors of mortality, MI and AKI after EVAR and to compare AKI incidence with Vascular Surgery Kidney Injury Predictive Score (VSKIPS). Methods: We conducted a retrospective study of EVAR procedures performed between March 2006 and November 2013. We defined mortality at 30 days, MI as an increase in troponin level to >0.034 ng mL -1 in the first 72 h and AKI as an increase in creatinine level to >0.3 mg dL -1 in the first 48 h after surgery. Risk factors were analysed using logistic regression calculating Hosmer-Lemeshow test and the area under the receiver operating curve (AUROC). Results: Ninety-eight patients were included in the study. The incidence of mortality, MI, and AKI was 2%, 5%, and 18%, respectively. AKI increased the risk of MI [odds ratio (OR) 24.4, p=0.006]. Preoperative serum urea level of >50 mg dL -1 (OR 4.97, p=0.038), general anaesthesia (OR 9.64, p=0.002) and surgery duration (OR 1.53, p=0.043) were considered independent predictors of AKI. The AUROC of the AKI model was 0.886 compared with 0.793 of VSKIPS. Conclusion: We found the incidence of mortality, MI and AKI consistent with that of previous studies. However, we may be underestimating the last two because of the short follow-up time. AKI was an independent predictor of MI. Preoperative serum urea level of >50 mg dL

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Section: Discussionsupporting

confidence: 92%

Complications of Endovascular Aneurysm Repair: Mortality, Myocardial Infarction and Acute Kidney Injury

Reis¹,

Morgado²,

Valdoleiros³

et al. 2018

Turk J Anaesth Reanim

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“…28 They showed that 43 of 156 (28%) patients undergoing branch or fenestrated repairs developed AKI with a univariate statistically significant difference in contrast material volumes between the two groups. The event rate in their cohort is too low to support the proposed nine covariate multivariable logistic regression, which is further confounded by more than double the number of accessory renal arteries covered in the AKI group in comparison to the no AKI group.…”

Section: Discussionmentioning

confidence: 99%

Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair

Zarkowsky

Hicks

Bostock

et al. 2016

Journal of Vascular Surgery

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Objective The reported frequency of renal dysfunction after elective endovascular aneurysm repair (EVAR) varies widely in current surgical literature. Published research establishes pre-existing end-stage renal disease as a poor prognostic indicator. We intend to quantify the mortality effect associated with renal morbidity developed postoperatively and to identify modifiable risk factors. Methods All elective EVAR patients with preoperative and postoperative renal function data captured by the Vascular Quality Initiative between January 2003 and December 2014 were examined. The primary study end point was long-term mortality. Preoperative, intraoperative, and postoperative parameters were analyzed to estimate mortality stratified by renal outcome and to describe independent risk factors associated with post-EVAR renal dysfunction. Results This study included 14,475 elective EVAR patients, of whom 96.8% developed no post-EVAR renal dysfunction, 2.9% developed acute kidney injury, and 0.4% developed a new hemodialysis requirement. Estimated 5-year survival was significantly different between groups, 77.5% vs 53.5%, respectively, for the no dysfunction and acute kidney injury groups, whereas the new hemodialysis group demonstrated 22.8% 3-year estimated survival (P < .05). New-onset postoperative congestive heart failure (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.18-10.38), return to the operating room (OR, 3.26; 95% CI, 1.49-7.13), and postoperative vasopressor requirement (OR, 2.68; 95% CI, 1.40-5.12) predicted post-EVAR renal dysfunction, whereas a preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 was protective (OR, 0.33; 95% CI, 0.21-0.53). Volume of contrast material administered during elective EVAR varies 10-fold among surgeons in the Vascular Quality Initiative database, but the average volume administered to patients is statistically similar, regardless of preoperative eGFR. Multivariable logistic regression demonstrated nonsignificant correlation between contrast material volume and postoperative renal dysfunction. Conclusions Any renal dysfunction developing after elective EVAR is associated with decreased estimated long-term survival. Protecting renal function with a rational dosing metric for contrast material linked to preoperative eGFR may better guide treatment.

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“…44 Following the publication of our meta-analysis, Sailer et al 46 reported an AKI incidence of 28% using the AKIN criteria in 157 patients undergoing fEVAR or bEVAR and Ducasse et al 47 reported an incidence of 32% in a similar fEVAR population. Following the above, it is clear that the incidence of AKI after EVAR has previously been underestimated and true incidence is close to 15-20% in up to date series using acceptable reporting criteria.…”

Section: Introductionmentioning

confidence: 91%

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

Jhaveri

Saratzis

Wanchoo

et al. 2017

Kidney International

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Endovascular treatment of complex aortic aneurysms: prevalence of acute kidney injury and effect on long-term renal function

Cited by 41 publications

References 28 publications

Complications of Endovascular Aneurysm Repair: Mortality, Myocardial Infarction and Acute Kidney Injury

Complications of Endovascular Aneurysm Repair: Mortality, Myocardial Infarction and Acute Kidney Injury

Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

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