Liesa Zabrocki1, Frank Marquardt2, Klaus Albrecht3, Stefan Herget-Rosenthal4,5. 1. Department of Medicine, Rotes Kreuz Krankenhaus, St.-Pauli-Deich 24, 28199, Bremen, Germany. 2. Department of Vascular Medicine, Rotes Kreuz Krankenhaus, Bremen, Germany. 3. Controlling, Rotes Kreuz Krankenhaus, Bremen, Germany. 4. Department of Medicine, Rotes Kreuz Krankenhaus, St.-Pauli-Deich 24, 28199, Bremen, Germany. herget-rosenthal.s@roteskreuzkrankenhaus.de. 5. Department of Nephrology, University Duisburg-Essen, Essen, Germany. herget-rosenthal.s@roteskreuzkrankenhaus.de.
Abstract
PURPOSE: Acute kidney injury (AKI) is a severe complication after infrarenal abdominal aortic aneurysm (iAAA) repair. Little data are available whether endovascular aneurysm (EVAR) or open aortic repair (OAR) differs with respect to AKI frequency and severity, consecutive development of chronic kidney disease (CKD) and potentially preventable and modifiable risk factors of AKI. PATIENTS AND METHODS: We assessed AKI rates, AKI stages and CKD applying current, complete definitions from the kidney disease improving global outcomes initiative in propensity-score-matched cohorts of all patients with elective and urgent iAAA repair at our institution from 2007 to 2011. Risk factors were analysed using multivariate logistic regression analyses. RESULTS: From 268 patients, we identified 91 matched pairs who had undergone either EVAR or OAR. The AKI rate was 13.2% with EVAR versus 41.8% with OAR (P < 0.001). AKI was significantly less severe in EVAR. OAR patients lost more glomerular filtration rate (- 11.3 vs. - 6.5%; P = 0.02) and developed more frequently CKD (14.3 vs. 3.2%; P < 0.001) 3 months after iAAA repair. EVAR, circulatory shock, radiocontrast media, rhabdomyolysis and sepsis were identified as potentially preventable or modifiable risk factors of AKI. CONCLUSIONS: AKI is significantly less frequent and severe in iAAA patients after EVAR as compared to OAR. Furthermore OAR patients demonstrate a higher CKD rate. The identified risk factors may be prevented or modified as a bundle of measures especially in patients with pre-existing CKD to reduce AKI and its severity after iAAA repair.
PURPOSE:Acute kidney injury (AKI) is a severe complication after infrarenal abdominal aortic aneurysm (iAAA) repair. Little data are available whether endovascular aneurysm (EVAR) or open aortic repair (OAR) differs with respect to AKI frequency and severity, consecutive development of chronic kidney disease (CKD) and potentially preventable and modifiable risk factors of AKI. PATIENTS AND METHODS: We assessed AKI rates, AKI stages and CKD applying current, complete definitions from the kidney disease improving global outcomes initiative in propensity-score-matched cohorts of all patients with elective and urgent iAAA repair at our institution from 2007 to 2011. Risk factors were analysed using multivariate logistic regression analyses. RESULTS: From 268 patients, we identified 91 matched pairs who had undergone either EVAR or OAR. The AKI rate was 13.2% with EVAR versus 41.8% with OAR (P < 0.001). AKI was significantly less severe in EVAR. OAR patients lost more glomerular filtration rate (- 11.3 vs. - 6.5%; P = 0.02) and developed more frequently CKD (14.3 vs. 3.2%; P < 0.001) 3 months after iAAA repair. EVAR, circulatory shock, radiocontrast media, rhabdomyolysis and sepsis were identified as potentially preventable or modifiable risk factors of AKI. CONCLUSIONS: AKI is significantly less frequent and severe in iAAApatients after EVAR as compared to OAR. Furthermore OAR patients demonstrate a higher CKD rate. The identified risk factors may be prevented or modified as a bundle of measures especially in patients with pre-existing CKD to reduce AKI and its severity after iAAA repair.
Authors: Konstantinos M Pirgakis; Konstantinos Makris; Ilias Dalainas; Andreas M Lazaris; Chrisostomos K Maltezos; Christos D Liapis Journal: Ann Vasc Surg Date: 2014-05-21 Impact factor: 1.466
Authors: Mitchell M Levy; Mitchell P Fink; John C Marshall; Edward Abraham; Derek Angus; Deborah Cook; Jonathan Cohen; Steven M Opal; Jean-Louis Vincent; Graham Ramsay Journal: Crit Care Med Date: 2003-04 Impact factor: 7.598
Authors: Adam Linder; Chris Fjell; Adeera Levin; Keith R Walley; James A Russell; John H Boyd Journal: Am J Respir Crit Care Med Date: 2014-05-01 Impact factor: 21.405
Authors: Monique Prinssen; Eric L G Verhoeven; Jaap Buth; Philippe W M Cuypers; Marc R H M van Sambeek; Ron Balm; Erik Buskens; Diederick E Grobbee; Jan D Blankensteijn Journal: N Engl J Med Date: 2004-10-14 Impact factor: 91.245
Authors: Ron Wald; Sushrut S Waikar; Orfeas Liangos; Brian J G Pereira; Glenn M Chertow; Bertrand L Jaber Journal: J Vasc Surg Date: 2006-03 Impact factor: 4.268
Authors: Pantelis Sarafidis; Sven Martens; Athanasios Saratzis; Daniella Kadian-Dodov; Patrick T Murray; Catherine M Shanahan; Allen D Hamdan; Daniel T Engelman; Ulf Teichgräber; Charles A Herzog; Michael Cheung; Michel Jadoul; Wolfgang C Winkelmayer; Holger Reinecke; Kirsten Johansen Journal: Cardiovasc Res Date: 2022-09-20 Impact factor: 13.081