Acute renal injury after thoracic endovascular aortic repair of Stanford type B aortic dissection: Incidence, risk factors, and prognosis

Zhu, Jiancheng; Chen, Shao‐Liang; Jin, Guishan; Shao, Ming-Xue; Kan, Jing; Lu, Cun-Yu; Xu, Hao

doi:10.1016/j.jfma.2014.01.017

Cited by 22 publications

(23 citation statements)

References 29 publications

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“…Patients in stages 2 and 3 had significant higher rates of in-hospital mortality and major adverse events. Similar incidence of AKI was found in the study by Zhu et al, 23 which identified AKI in 48 (30.8%) of 156 TEVAR for TBAD patients according to RIFLE (risk, injury, failure, lose and end-stage renal disease) classification, with 7 (14.5%) patients requiring continuous RRT. Other previous studies, however, have suggested the rates of AKI after endovascular repair varying from 1.5% to 34%.…”

Section: Discussionsupporting

confidence: 85%

“… 5 – 7 The rates of postprocedure AKI after endovascular repair for thoracic or abdominal aortic aneurysm alone were relatively low ranging from 2% to 17%, 26 – 29 when compared with TEVAR for TBAD which ranged from 27.5% to 30.8%. 23 The differences in pathophysiology between aortic dissection and aneurysm may also be factor to consider, including hemodynamic changes by the TL/FL, the dissection flap, the load of contrast agent and the controlled BP depressurization during stent deployment.…”

Section: Discussionmentioning

confidence: 99%

“…These factors may take the responsibility for a higher incidence of AKI after TEVAR. 23 , 30 , 32 , 33 …”

Section: Discussionmentioning

confidence: 99%

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Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection

Luo¹,

Ding²,

Luo³

et al. 2017

TCRM

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BackgroundThoracic endovascular aortic repair (TEVAR) has become an emerging treatment modality for acute type B aortic dissection (TBAD) patients in recent years. The risk factors and impacts of acute kidney injury (AKI) after percutaneous TEVAR, however, have not been widely established.MethodsWe retrospectively studied the clinical records of 305 consecutive patients who admitted to our institution and had TEVAR for TBAD between December 2009 and June 2013. The patients were routinely monitored for their renal functions preoperatively until 7 days after TEVAR. The Kidney Disease Improving Global Guidelines (KDIGO) criteria were used for AKI.ResultsOf the total 305 consecutive patients, 84 (27.5%) developed AKI after TEVAR, comprising 66 (21.6%) patients in KDIGO stage 1, 6 (2.0%) patients in stage 2 and 12 (3.9%) patients in stage 3. From the logistic regression analysis, systolic blood pressure (SBP) on admission >140 mmHg (odds ratio [OR], 2.288; 95% CI, 1.319–3.969) and supra-aortic branches graft bypass hybrid surgery (OR, 3.228; 95% CI, 1.526–6.831) were independent risk factors for AKI after TEVAR. Local anesthesia tended to be a protective factor (OR, 0.563; 95% CI, 0.316–1.001). The preoperative renal function, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or statin administration, volume of contrast agent, range of TBAD and false lumen involving renal artery were not associated with post-operation AKI. The in-hospital mortality and major adverse events were markedly increased with the occurrence of AKI (7.1% vs 0.9%, P=0.006; 14.3% vs 3.2%, P<0.001, respectively).ConclusionsTEVAR for TBAD has a high incidence of AKI, which is associated with worse in-hospital outcomes. SBP on admission and supra-aortic branches graft bypass hybrid surgery were the most significant risk factors. Renopreventive measures should be considered in high-risk patients.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection

Luo¹,

Ding²,

Luo³

et al. 2017

TCRM

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“…Retrospective studies have been undertaken to assess the prevalence and the clinical and biochemical features of AKI following clindamycin treatment (6)(7)(8). AKI related to the administration of clindamycin is generally associated with oligoanuria, the same as in our patient.…”

Section: Discussionmentioning

confidence: 87%

Clindamycin-induced Kidney Diseases: A Retrospective Analysis of 50 Patients

Wan

Wang

et al. 2016

Intern. Med.

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Objective There are many adverse reactions due to clindamycin, but kidney diseases (acute kidney injury, AKI) are uncommon. However, in recent years, the rate of clindamycin-induced kidney diseases has increased. We analyzed 50 patients with clindamycin-induced kidney diseases retrospectively, and investigated the characteristics of these kidney diseases in order to provide a reference for rational clinical drug use and to reduce drug-induced organ damage. Methods We investigated 50 patients diagnosed with clindamycin-induced kidney diseases retrospectively at the Department of Nephrology, Shandong University Qilu Hospital, from January 2009 to December 2013. The parameters included in our study were age, sex, clinical manifestations, efficacy and prognosis. Results All patients were diagnosed with clindamycin-induced kidney diseases within 48 hours of the application of clindamycin at 1.0-2.0 g/day. The patients included 29 women and 21 men. Most of the enrolled patients were 20-59 years old. Fifty-one patients were diagnosed with AKI stage 3 upon admission. Thirtythree had episodes of gross hematuria, but fever, skin rash and eosinophilia were rare. Urine analysis revealed mild proteinuria and severe tubular dysfunction. In the majority of patients, AKI was severe and required renal replacement therapy, but renal function in all patients had recovered significantly two months after discharge. Conclusion Clindamycin-induced AKI is largely reversible and is associated with episodes of gross hematuria. Clinicians should use clindamycin rationally and reduce the incidence of adverse reactions.

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“…The incidence of acute kidney injury (AKI) after TEVAR has been reported to be 1% to 34% [ 4 ]. This relatively common complication of TEVAR is associated with prolonged hospital stays and increased risk of mortality [ 5 – 7 ]. The goal of this clinical research was to investigate the risk factors and impact of AKI after TEVAR.…”

Section: Introductionmentioning

confidence: 99%

The Risk Factors and Outcomes of Acute Kidney Injury after Thoracic Endovascular Aortic Repair

Jeon

Bae

2016

Korean J Thorac Cardiovasc Surg

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BackgroundWe aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR).MethodsA total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed.ResultsUnderlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was 61.2±17.5 years (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival.ConclusionPreoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.

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Acute renal injury after thoracic endovascular aortic repair of Stanford type B aortic dissection: Incidence, risk factors, and prognosis

Abstract: A significant rate of AKI was observed following TEVAR and was associated with an increase in 30-day and 1-year mortality. Malperfusion complications were identified as an independent predictor of AKI.

Cited by 22 publications

References 29 publications

Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection

Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection

Clindamycin-induced Kidney Diseases: A Retrospective Analysis of 50 Patients

The Risk Factors and Outcomes of Acute Kidney Injury after Thoracic Endovascular Aortic Repair

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