Patterns And Trends Of Acute Kidney Injury After Aortic Aneurysm Repair. A 5-year Experience
Zdenek Novak, MD, PhD, Ahmed F. Zaky, MD, Emily L. Spangler, MD, Graeme E. McFarland, MD, Adam W. Beck.
University of Alabama at Birmingham, Birmingham, AL, USA.
OBJECTIVES: Postoperative acute kidney injury (pAKI) is a known complication of aortic aneurysm repairs with substantial morbidity, mortality and healthcare expense. In this restrospective study, we aim to address pAKI risk and long term patterns after open and endovascular aortic aneurysm repairs.
METHODS: Demographics, hospitalization, and long-term clinical and lab data were retrieved from the EMR for patients undergoing aortic repair between 2012-17 at a single institution. Procedure types included: EVAR, TEVAR, Open AAA, OpenTAA and Aorto-Femoral bypass (AF). pAKI was defined per Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria (scored 0-3 from no injury to dialysis progression). Predictors of pAKI and renal function at 1-3 years were assessed.
RESULTS: Of a total of 773 patients, 37.6% underwent EVAR, 27.7% TEVAR, 5.3% OpenTAAA), 13.1% OpenAAA and 16.0% AF. pAKI occurred in 11.6%, 18.7%, 62.8%, 45.5% and 29.0% respectively. In multivariable analysis pAKI was significantly associated with suprarenal clamp (compared to endovascular repairs without aortic clamping), preoperative eGFR, prior history of CKD or AKI, while male gender and ASA use were protective. Long term data were available for 329 patients, 37.6% with no pAKI developed a new delayed worsening in renal function grade, 63.8% with pAKI further deteriorated in renal function grade. Factors significantly associated with worsening renal function were: preoperative estimated glomerular filtration rate, antiplatelet use and RIFLE grade 1 vs 0. Higher Preoperative albumin level was protective from long-term renal deterioration. Patients with pAKI, experienced 3-times higher 1-year mortality rates (14.2% vs 4.6%, P<0.001). Factors associated with mortality were: CHF history, pAKI, endovascular procedure and older age.
CONCLUSIONS: pAKI is more common in open repairs and with suprarenal clamping and is associated with a high mortality. A delayed decline of renal function is commonly seen in long-term follow-up. More sensitive indicators of renal structure and function should be sought before and after surgery to guide therapy and prevent progressive renal failure.
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