Impact of Mild Acute Kidney Injury (AKI) on Outcome after Open Repair of Aortic Aneurysms

Abstract

Recently, mild AKI has been considered as a risk factor for mortality in different scenarios. We conducted a retrospective analysis of the risk factors for two distinct definitions of AKI after elective repair of aortic aneurysms. Logistic regression was carried out to identify independent risk factors for AKI (defined as Ն25% or Ն50% increase in baseline SCr within 48 h after surgery, AKI 25% and AKI 50%, respectively) and for mortality. Of 77 patients studied (mean age 68 ± 10, 83% male), 57% developed AKI 25% and 33.7% AKI 50%. There were no differences between AKI and control groups regarding comorbidities and diameter of aneurysms. However, AKI patients needed a supra-renal aortic cross-clamping more frequently and were more severely ill. Overall in-hospital mortality was 27.3%, which was markedly higher in those requiring a supra-renal aortic cross-clamping. The risk factors for AKI 25% were suprarenal aortic cross-clamping (odds ratio 5.51, 95% CI 1.05-36.12, p = 0.04) and duration of operation for AKI 25% (OR 6.67, 95% CI 2.23-19.9, p < 0.001). For AKI 50%, in addition to those factors, post-operative use of vasoactive drugs remained as an independent factor (OR 6.13, 95% CI 1.64-22.8, p = 0.005). The risk factors associated with mortality were need of supra-renal aortic cross-clamping (OR 9.6, 95% CI 1.37-67.88, p = 0.02), development of AKI 50% (OR 8.84, 95% CI 1.31-59.39, p = 0.02), baseline GFR lower than 49 mL/min (OR 17.07, 95% CI 2.00-145.23, p = 0.009), and serum glucose > 118 mg/dL in the post-operative period (OR 19.99, p = 0.006). An increase of at least 50% in baseline SCr is a common event after surgical repair of aortic aneurysms, particularly when a supra-renal aortic cross-clamping is needed. Along with baseline moderate chronic renal failure, AKI is an independent factor contributing to the high mortality found in this scenario.

Risk factors and outcomes associated with acute kidney injury following ruptured abdominal aortic aneurysm

“…vasoactive therapy) [7,8,26]. Our results confirm these prior findings, showing longer operative duration, greater intra-operative blood loss and illness severity portend an increased risk for post-operative AKI.…”

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

“…Another limitation of the study is the low number of AKIþ patients in the EVAR group, which negatively affects a statistical comparison between the two types of intervention. Finally, many potentially interesting data that have been evaluated in previous works are lacking: intensive care unit stays, 18 postoperative hemodynamic parameters, 11 intraoperative and perioperative fluid management, 19,20 contrast agent use, 5 blood losses, 5 impact of suprarenal fixation, 21 and longterm assessment of renal function. 22 A detailed report of all these parameters would have added many points of consideration to the discussion.…”

Antecedent acute kidney injury worsens subsequent endotoxin-induced lung inflammation in a two-hit mouse model

“…Although several patient populations carry high risk for renal ischemia [patients undergoing abdominal aneurysm repair requiring suprarenal aortic cross clamping (32) or patients undergoing cardiopulmonary bypass (8,36)], it can be argued that systemic illness from isolated renal ischemia is likely a clinical non sequitur. However, the proposed model seeks to underscore the potential contribution of the kidney to deleterious lung priming during common ischemic states such as hypovolemia.…”