Acute kidney injury after open and endovascular elective repair for infrarenal abdominal aortic aneurysms

Abstract

Objective: The aim of this study was to evaluate the incidence of acute kidney injury (AKI) after open and endovascular abdominal aortic aneurysm repair according to the Aneurysm Renal Injury Score classification. Methods: We retrospectively evaluated 431 patients undergoing elective open aortic repair (OAR; n [ 285) or endovascular repair (n [ 146) for infrarenal aortic aneurysm. All data regarding preoperative and postoperative serum creatinine concentrations and postoperative outcomes were assessed. Univariate and multivariate logistic regression models investigated the association between AKI and different risk factors and complications. Results: The incidence of AKI was significantly higher after OAR (26.3% vs 5.5%; P < .001). A significant share of patients who experienced AKI were restored to preoperative renal function at discharge (62.5% vs 77.5% in the endovascular and OAR groups, respectively; P [ .37). Preoperative serum creatinine concentration was significantly higher in those patients who further developed AKI (1.25 vs 1.04 mg/dL; P < .001). At the multivariate analysis, AKI was significantly associated with current smoking (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.19-3.52; P [ .01), hypertension (OR, 2.46; 95% CI, 1.21-4.3; P [ .01), chronic renal disease (OR, 2.53; 95% CI, 1.42-4.53; P < .001), OAR (OR, 7.3; 95% CI, 3.25-16.42; P < .001), and arrhythmias (OR, 3.16; 95% CI, 1.09-9.13; P [ .03). AKI stage did not affect postoperative outcomes, except for a longer hospital stay in patients in stage 2 and stage 3 compared with stage 1. Conclusions: AKI is a common but often reversible complication, especially after OAR. There is an urgent need of a common classification for AKI after aortic surgery. New diagnostic markers for AKI should be evaluated in large-scale studies to assess their reliability. (J Vasc Surg 2016;64:928-33.)

Predictors of Acute Kidney Injury Following Elective Open and Endovascular Aortic Repair for Abdominal Aortic Aneurysm

“…Using ARISe, Castagno et al recently reported that the incidence of postoperative AKI was 26.3% (75/285) and 5.5% (8/146) in patients who underwent elective OAR and EVAR, respectively. 5 ) In a large-scale study, Zarkowsky et al collected data on preoperative and postoperative serum creatinine concentration from the Vascular Quality Initiative database. 7 ) They reported that only 2.9% of the 14,475 non-hemodialysis patients who underwent elective EVAR developed AKI, which was defined as an increase in serum creatinine concentration>0.5 mg/dL, and 0.4% newly required hemodialysis.…”

“…Preoperative renal dysfunction was reported to increase the risk of AKI after elective surgery for AAA. 3 , 5 , 10 ) Tang et al reported that preoperative eGFR >60 mL/min/1.73 m 2 was associated with a 0.957-fold decreased risk of AKI in combined patient analysis for both OAR and EVAR. 3 ) Castagno et al similarly reported that chronic renal disease, defined as a preoperative serum creatinine concentration>1.2 mg/dL, was associated with a 2.53-fold increased risk of AKI in combined patient analysis for both OAR and EVAR.…”

“…Postoperative AKI is associated with not only early mortality 3 – 5 ) but also survival, 4 , 6 , 7 ) cardiovascular events, 8 ) and aneurysm-related death 9 ) in the late follow-up period. Although EVAR may decrease the risk of AKI, 3 , 5 , 10 – 14 ) the reported incidence rates of AKI widely range from 12.4% to 36.2% for elective OAR 4 , 5 , 11 , 15 , 16 ) and 2.9% to 18.8% for elective EVAR. 5 , 7 , 11 , 17 ) Complexity in research on AKI in this area might be caused by heterogenous manifestations, such as ruptured or unruptured, and the involvement of aneurysm requiring suprarenal aortic clamp.…”

“…Although EVAR may decrease the risk of AKI, 3 , 5 , 10 – 14 ) the reported incidence rates of AKI widely range from 12.4% to 36.2% for elective OAR 4 , 5 , 11 , 15 , 16 ) and 2.9% to 18.8% for elective EVAR. 5 , 7 , 11 , 17 ) Complexity in research on AKI in this area might be caused by heterogenous manifestations, such as ruptured or unruptured, and the involvement of aneurysm requiring suprarenal aortic clamp. In addition, differences in AKI classification systems among studies make the comparison of research on AKI complicated.…”

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

“…1) Suprarenal clamping implies renal ischemia, which may increase in-hospital mortality 1) and the incidence of postoperative acute kidney injury (AKI). [2][3][4][5][6][7] Postoperative AKI is a common, but serious, complication of aortic repair for AAA because it may increase early mortality 8,9) and patients hospital stay 10,11) ; it may also affect late survival. 8,12,13) Although much attention to date has been given to this complication, research into AKI following AAA repair remains challenging due to the fact that AAAs differ from each other morphologically and clinically.…”