BACKGROUND: Little is known about acute changes in renal function in the postoperative period and the outcome of patients undergoing major vascular surgery. Specifically, data are scarce for patients in whom renal function temporarily decreases and returns to baseline at 3 days after surgery. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 1,324 patients who underwent elective open abdominal aortic aneurysm surgery in a single center. PREDICTOR: Renal function (creatinine clearance was measured preoperatively and on days 1, 2, and 3 after surgery. Patients were divided into 3 groups: group 1, improved or unchanged (change in creatinine clearance, +/-10% of function compared with baseline); group 2, temporary worsening (worsening > 10% at day 1 or 2, then complete recovery within 10% of baseline at day 3); and group 3, persistent worsening (>10% decrease compared with baseline). OUTCOMES & MEASUREMENTS: All-cause mortality. RESULTS: 30-day mortality rates were 1.3%, 5.0%, and 12.6% in groups 1 to 3, respectively. Adjusted for baseline characteristics and postoperative complications, 30-day mortality was the greatest in patients with persistent worsening of renal function (hazard ratio [HR], 7.3; 95% confidence interval [CI], 2.7 to 19.8), followed by those with temporary worsening (HR, 3.7; 95% CI, 1.4 to 9.9). During 6.0 +/- 3.4 years of follow-up, 348 patients (36.5%) died. Risk of late mortality was 1.7 (95% CI, 1.3 to 2.3) in the persistent-worsening group followed by those with temporary worsening (HR, 1.5; 95% CI, 1.2 to 1.4). LIMITATIONS: No steady state was achieved to assess renal function. CONCLUSION: Although renal function may recover completely after aortic surgery, temporary worsening of renal function was associated with greater long-term mortality.
BACKGROUND: Little is known about acute changes in renal function in the postoperative period and the outcome of patients undergoing major vascular surgery. Specifically, data are scarce for patients in whom renal function temporarily decreases and returns to baseline at 3 days after surgery. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 1,324 patients who underwent elective open abdominal aortic aneurysm surgery in a single center. PREDICTOR: Renal function (creatinine clearance was measured preoperatively and on days 1, 2, and 3 after surgery. Patients were divided into 3 groups: group 1, improved or unchanged (change in creatinine clearance, +/-10% of function compared with baseline); group 2, temporary worsening (worsening > 10% at day 1 or 2, then complete recovery within 10% of baseline at day 3); and group 3, persistent worsening (>10% decrease compared with baseline). OUTCOMES & MEASUREMENTS: All-cause mortality. RESULTS: 30-day mortality rates were 1.3%, 5.0%, and 12.6% in groups 1 to 3, respectively. Adjusted for baseline characteristics and postoperative complications, 30-day mortality was the greatest in patients with persistent worsening of renal function (hazard ratio [HR], 7.3; 95% confidence interval [CI], 2.7 to 19.8), followed by those with temporary worsening (HR, 3.7; 95% CI, 1.4 to 9.9). During 6.0 +/- 3.4 years of follow-up, 348 patients (36.5%) died. Risk of late mortality was 1.7 (95% CI, 1.3 to 2.3) in the persistent-worsening group followed by those with temporary worsening (HR, 1.5; 95% CI, 1.2 to 1.4). LIMITATIONS: No steady state was achieved to assess renal function. CONCLUSION: Although renal function may recover completely after aortic surgery, temporary worsening of renal function was associated with greater long-term mortality.
Authors: Jan-Peter van Kuijk; Willem-Jan Flu; Michel Chonchol; Sanne E Hoeks; Tamara A Winkel; Hence J M Verhagen; Jeroen J Bax; Don Poldermans Journal: Clin J Am Soc Nephrol Date: 2010-04-29 Impact factor: 8.237
Authors: Derek P DiRocco; John Bisi; Patrick Roberts; Jay Strum; Kwok-Kin Wong; Norman Sharpless; Benjamin D Humphreys Journal: Am J Physiol Renal Physiol Date: 2013-12-11
Authors: Steven G Coca; Joseph T King; Ronnie A Rosenthal; Melissa F Perkal; Chirag R Parikh Journal: Kidney Int Date: 2010-08-04 Impact factor: 10.612
Authors: Carlo Andrea Bravi; Emily Vertosick; Nicole Benfante; Amy Tin; Daniel Sjoberg; A Ari Hakimi; Karim Touijer; Francesco Montorsi; James Eastham; Paul Russo; Andrew Vickers Journal: Eur Urol Date: 2019-05-10 Impact factor: 20.096
Authors: Steven M Brunelli; Sushrut S Waikar; Brian T Bateman; Tara I Chang; Joyce Lii; Amit X Garg; Wolfgang C Winkelmayer; Niteesh K Choudhry Journal: Am J Med Date: 2012-10-09 Impact factor: 4.965
Authors: Virendra I Patel; Robert T Lancaster; Emel Ergul; Mark F Conrad; Daniel Bertges; Marc Schermerhorn; Philip Goodney; Richard P Cambria Journal: J Vasc Surg Date: 2015-12 Impact factor: 4.268
Authors: Lior Fuchs; Joon Lee; Victor Novack; Yael Baumfeld; Daniel Scott; Leo Celi; Tal Mandelbaum; Michael Howell; Daniel Talmor Journal: Chest Date: 2013-09 Impact factor: 9.410