OBJECTIVE: Clinically evident renal disease is a risk factor for mortality after aneurysm repair. Serum creatinine is widely used as a measure of renal function in the preoperative evaluation of patients. Unfortunately, serum creatinine concentration is influenced by muscle mass, hydration status, and glomerular filtration rate (GFR). Calculated GFR, which takes predictors of muscle mass such as age, gender, and weight into account, is a more sensitive determinant of renal function than serum creatinine. We hypothesized that GFR would more accurately predict mortality after EVAR than serum creatinine. METHODS: We retrospectively evaluated our database of 398 patients who underwent EVAR with the AneuRx device between October 1999 and October 2004. There were 340 men and 58 women with a mean age of 73. GFR was calculated using the Cockcroft-Gault equation. The patients were divided into four quartiles by preoperative GFR: I (7 to 45), II (45 to 60), III (61 to 79), and IV (> or =80). Survival was estimated with the Kaplan-Meier method, and heterogeneity of mortality across strata was evaluated using the log-rank test. The GFR quartiles were compared with clinically accepted criteria for abnormal renal function (serum creatinine level > or =1.7). RESULTS: Actuarial survival at 48 months was 61.5%, 70.5%, 86.0%, and 85.7% for GFR quartiles I to IV, respectively (P < .003). Thirty-day mortality was 2.2% in quartile I, 3.2% in quartile II, and 0 in quartiles III and IV (P = .03 for q1 + q2 vs q3 + q4, P < .02 for q2 vs q3 + q4). Survival curves for quartiles II to IV were statistically indistinguishable, with quartile II running tangential to the two higher quartiles after the perioperative period. Quartile I fared significantly worse than the other three quartiles for the entire follow-up period (P < .005). According to American Kidney Foundation criteria (GFR <90), 83.3% of patients had abnormal renal function compared with 16.1% with abnormal serum creatinine (>1.7) (P < .0002). CONCLUSION: The risk of perioperative and long-term mortality in patients undergoing EVAR is more accurately stratified by using calculated GFR than serum creatinine alone. A GFR <45 is associated with decreased survival after EVAR. Perioperative mortality at a GFR of 45 to 60 is comparable with that of the lower quartile (GFR <45), but late survival is comparable with that of patients with GFR >60. The finding of increased risk of early mortality in patients in the 45 to 60 GFR range, with survivors enjoying good long-term outcome, suggests that these patients may most benefit from the use of alternative contrast agents and periprocedural renal protection techniques.
OBJECTIVE: Clinically evident renal disease is a risk factor for mortality after aneurysm repair. Serum creatinine is widely used as a measure of renal function in the preoperative evaluation of patients. Unfortunately, serum creatinine concentration is influenced by muscle mass, hydration status, and glomerular filtration rate (GFR). Calculated GFR, which takes predictors of muscle mass such as age, gender, and weight into account, is a more sensitive determinant of renal function than serum creatinine. We hypothesized that GFR would more accurately predict mortality after EVAR than serum creatinine. METHODS: We retrospectively evaluated our database of 398 patients who underwent EVAR with the AneuRx device between October 1999 and October 2004. There were 340 men and 58 women with a mean age of 73. GFR was calculated using the Cockcroft-Gault equation. The patients were divided into four quartiles by preoperative GFR: I (7 to 45), II (45 to 60), III (61 to 79), and IV (> or =80). Survival was estimated with the Kaplan-Meier method, and heterogeneity of mortality across strata was evaluated using the log-rank test. The GFR quartiles were compared with clinically accepted criteria for abnormal renal function (serum creatinine level > or =1.7). RESULTS: Actuarial survival at 48 months was 61.5%, 70.5%, 86.0%, and 85.7% for GFR quartiles I to IV, respectively (P < .003). Thirty-day mortality was 2.2% in quartile I, 3.2% in quartile II, and 0 in quartiles III and IV (P = .03 for q1 + q2 vs q3 + q4, P < .02 for q2 vs q3 + q4). Survival curves for quartiles II to IV were statistically indistinguishable, with quartile II running tangential to the two higher quartiles after the perioperative period. Quartile I fared significantly worse than the other three quartiles for the entire follow-up period (P < .005). According to American Kidney Foundation criteria (GFR <90), 83.3% of patients had abnormal renal function compared with 16.1% with abnormal serum creatinine (>1.7) (P < .0002). CONCLUSION: The risk of perioperative and long-term mortality in patients undergoing EVAR is more accurately stratified by using calculated GFR than serum creatinine alone. A GFR <45 is associated with decreased survival after EVAR. Perioperative mortality at a GFR of 45 to 60 is comparable with that of the lower quartile (GFR <45), but late survival is comparable with that of patients with GFR >60. The finding of increased risk of early mortality in patients in the 45 to 60 GFR range, with survivors enjoying good long-term outcome, suggests that these patients may most benefit from the use of alternative contrast agents and periprocedural renal protection techniques.
Authors: Piotr Buczkowski; Mateusz Puślecki; Natalia Majewska; Tomasz Urbanowicz; Marcin Misterski; Robert Juszkat; Jerzy Kulesza; Bartosz Żabicki; Sebastian Stefaniak; Marcin Ligowski; Lukasz Szarpak; Marek Jemielity; Eva Rivas; Kurt Ruetzler; Bartłomiej Perek Journal: J Thorac Dis Date: 2019-06 Impact factor: 2.895
Authors: Alan Karthikesalingam; Sandeep S Bahia; Shaneel R Patel; Bilal Azhar; Dan Jackson; Lynne Cresswell; Robert J Hinchliffe; Peter J E Holt; Matt M Thompson Journal: Kidney Int Date: 2014-08-20 Impact factor: 10.612
Authors: Felix Jv Schlösser; Geert Jmg van der Heijden; Yolanda van der Graaf; Frans L Moll; Hence Jm Verhagen Journal: J Med Case Rep Date: 2008-09-30