Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial

Bruin, Jorg L. de; Vervloet, Marc G.; Buimer, M.G.; Baas, Annette F.; Prinssen, Monique; Blankensteijn, Jan D.

doi:10.1002/bjs.9280

Cited by 46 publications

(14 citation statements)

References 34 publications

(41 reference statements)

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“…2,3,5,7-11 The 5-year 77.5% survival demonstrated by the study group not suffering renal morbidity aligns with long-term results from the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial. 10 Although it is an infrequent event, those patients unfortunate enough to have development or exacerbation of renal dysfunction after EVAR also demonstrate a distinct survival disadvantage. Decreased estimated life expectancy is associated with more severe renal dysfunction, as hypothesized.…”

Section: Discussionmentioning

confidence: 99%

“…6 An early series describing a single center’s experience in the late 1990s placed the frequency of a new HD requirement after elective EVAR at 3.5%. 7 Subsequent registry analyses and clinical trials refined this estimate to between 0.6% and 1.1% 2,3,5,8-10 ; acute and chronic kidney injuries are poorly characterized in these reports. Hua et al reported AKI appearing at a frequency of 0.9% in their National Inpatient Sample analysis, whereas Pisimisis et al identified that 17.2% of their cohort suffered a similar complication.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

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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“…The DREAM trial results only give data at the 5-year time point from 189 patients who remained available for follow-up – these data could not be used in our longest time point, which dealt with data closer to 1-year postoperatively (44). At 5 years they found that there was a mean difference in eGFR of 3.9 (95 per cent CI 1.3 to 6.5) ml per min per 1.73m2 in the EVAR group.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis indicates underreporting of renal dysfunction following endovascular aneurysm repair

Karthikesalingam

Bahia

Patel

et al. 2015

Kidney International

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Deterioration in renal function has been described after endovascular repair of abdominal aortic aneurysms (EVR). The aetiology is multifactorial and represents an important therapeutic target. A need exists to quantitatively summarise incidence and severity of renal dysfunction after EVR to allow better-informed attempts to preserve renal function and improve life expectancy. A systematic search was performed using Medline and Embase for renal function after EVR applying PRISMA statements. Univariate and multivariate random effects meta-analyses were performed to estimate pooled post-operative changes in serum creatinine and creatinine clearance at four time points after EVR: 0-7 days, 30 days/1 month, 1 month-1year and ≥1year. Clinically relevant deterioration in renal function was also estimated at ≥1year after EVR. 23 papers were identified for analysis. Pooled probability of clinically-relevant deterioration in renal function ≥1year was 18% (95% CI=14-23%,I²=82.5%). From univariate meta-analyses, serum creatinine increased after EVR by of 0.05mg/dL at 30 days/1month, 0.09mg/dL at 1 month to 1 year and 0.11mg/dL at ≥ 1 year (all p<0.05). Creatinine clearance reduced after EVR by 5.65 ml/min at 1 month-1 year and 6.58 ml/min at ≥1 year (both p<0.05). Renal failure after EVR is underreported and reporting standards are poorly followed. Clinically relevant deterioration in renal function is common and merits focussed attention to attenuate impact on long-term mortality.

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“…Furthermore, in most of the clinical trials carried out in the population of CKD patients, the use of a simple formula that estimates renal function using only serum creatinine value is extremely helpful and has a well-established efficacy [16,17,18]. Another practical advantage resulting from the use of formulas is the possibility to calculate a reliable value of renal function in the so-called “not nephrological” areas that host a large number of patients with renal disease, such as some hospital wards (cardiology, internal medicine, etc), specialist outpatient clinics for internal diseases (diabetes mellitus, arterial hypertension, dyslipidemia) or even the offices of primary care physicians.…”

Section: Discussionmentioning

confidence: 99%

Cross-Sectional Evaluation of Kidney Function in Hospitalized Patients: Estimated GFR Versus Renal Scintigraphy

Santoro¹,

Zappulla²,

Alibrandi³

et al. 2014

Kidney Blood Press Res

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Background/Aims: Accurate staging of chronic kidney disease (CKD) is very important. We tried to identify difference in GFR evaluation between CKD-EPI and Gates method with renal scintigraphy and which variables are associated with these differences. Methods: We retrospectively reviewed the records of 341 patients who underwent dynamic renal scintigraphy in the last 5 years. Patients were categorized according to KDIGO staging I to V, using the eGFR calculated with the CKD-EPI equation. Secondarily, we stratified patients according to treatment with renin-angiotensin system (RAS) inhibitors. Results: Gates method tends to underestimate GFR especially in CKD stage I (mean -22.2 ml/min) and II (mean -12.5 ml/min). The division in quartiles of ages showed an underestimation of GFR only in the first quartile of age (< 50 years old). Gates method underestimation of GFR was more pronounced in stage I patients treated with RAS inhibitors (mean -34.6 ml/min). The same occurs in stage II, even though to a lesser extent. Conclusion: The assessment of GFR by the Gates method must be carefully considered in the early stages of CKD, especially in younger patients. Moreover, the difference is more pronounced in patients treated with RAS inhibitors. Longitudinal studies will prove which method better predicts cardiovascular or renal events.

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Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial

Abstract: Renal function 5 years after OR and EVAR for AAA was similar. Neither surgical procedure accelerated the loss of renal function.

Cited by 46 publications

References 34 publications

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

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

A systematic review and meta-analysis indicates underreporting of renal dysfunction following endovascular aneurysm repair

Cross-Sectional Evaluation of Kidney Function in Hospitalized Patients: Estimated GFR Versus Renal Scintigraphy

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