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

Abstract

Objective: To investigate the predictors of acute kidney injury (AKI) following surgery for abdominal aortic aneurysm.Materials and Methods: Subjects were 642 non-hemodialysis patients (open aortic repair [OAR] group, n=453; endovascular aortic repair [EVAR] group, n=189) who underwent elective surgery between 2009 and 2015. AKI was assessed according to the Kidney Disease Improving Global Outcomes criteria. In-hospital mortality and incidence of AKI were compared between the OAR and EVAR groups. The effect of AKI on outcomes and predictors of AKI were examined in both groups.Results: In-hospital mortalities were 0.7% (3/453) in the OAR group and 0.5% (1/189) in the EVAR group. The incidence of AKI increased in the OAR group (14.1% vs. 3.7%, P<0.01). In the OAR group, in-hospital mortality (0% vs. 4.7%, P<0.01) increased in patients with AKI. In the OAR group, hemoglobin level <10 g/dL, estimated glomerular filtration rate <60 mL/min/1.73 m2, operation time >300 min, history of ischemic heart disease, and amount of bleeding >1,000 mL were predictors of AKI. In the EVAR group, amount of transfusion>1,000 mL was a predictor of AKI, but AKI was not found to worsen outcomes.Conclusion: AKI affected outcomes of OAR. Knowledge of predictors may optimize perioperative care.

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

“…We previously showed blood loss volume >1000 mL, preoperative hemoglobin<10 g/dL, and a long operating time (>300 min), to be predictors of postoperative AKI in patients who have undergone elective OAR with infrarenal clamping. 17) In comparison to OAR with infrarenal clamping, OAR with suprarenal clamping carries a high operative risk because wide mobilization of the viscera is often required, and the operative field is located deep in the retroperitoneal space. The 2012 Japanese Society for Vascular Surgery annual report documented a 2.3% in-hospital mortality among patients who underwent elective OAR with suprarenal clamping, a higher rate in comparison to the overall rate of 1.7% among patients who underwent elective OAR for AAA.…”

“…The assessment of postoperative AKI on the basis of the KDIGO criteria was as reported previously. 16,17,21) Briefly, each patient s estimated glomerular filtration rate was determined preoperatively and postoperatively by means of the Modification of Diet in Renal Disease study equation for Japanese patients, 22) and patients preoperative serum creatinine concentration was used as the baseline value. Detailed information regarding the KDIGO criteria is shown in Supplementary Material.…”

“…Resolution of AKI was defined as an increase of <0.3 mg/dL in the patient s serum creatinine concentration at discharge over the concentration on admission. 17) Other variables examined…”

“…Operative procedures were as reported previously. 17) All procedures were performed under general anesthesia, and no hybrid procedure combining OAR and an endovascular technique was performed in any of the study patients. OAR was typically performed by transperitoneal approach, and infrarenal aortic cross-clamping was performed in patients with non-juxtarenal AAA.…”

“…16) We recently reported the impact and predictors of AKI (defined by the KDIGO criteria), following elective OAR with infrarenal clamping. 17) We here conducted a retrospective study to determine the incidence and predictors of KDIGO-defined AKI following OAR performed with suprarenal clamping. Several renal protection techniques have been reported for use with suprarenal clamping [18][19][20] ; however, their efficacies in terms of renal function have not yet been fully clarified.…”