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2017 ; 18
(1
): 184
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The incidence, risk factors and in-hospital mortality of acute kidney injury in
patients after abdominal aortic aneurysm repair surgery
#MMPMID28569144
Tang Y
; Chen J
; Huang K
; Luo D
; Liang P
; Feng M
; Chai W
; Fung E
; Lan HY
; Xu A
BMC Nephrol
2017[May]; 18
(1
): 184
PMID28569144
show ga
BACKGROUND: Acute kidney injury (AKI) is a severe complication associated with
abdominal aortic aneurysm (AAA) repair. In this study, we evaluated the
incidence, risk factors and in-hospital mortality of AKI in patients after the
AAA repair surgery. METHODS: A total of 314 Chinese AAA patients who underwent
endovascular aneurysm repair (EVAR) or open aneurysm repair (OPEN) were enrolled
in this study. AKI was diagnosed according to the 2012 KDIGO criteria. Logistic
regression modeling was used to explore risk factors of AKI, while risk factors
associated with in-hospital mortality in AKI patients were investigated using Cox
proportional hazards model and Kaplan-Meier analysis, respectively.
Multicollinearity analysis was performed to identify the collinearity between the
variables before logistic regression analysis and Cox proportional hazards
analysis. RESULTS: Among 314 patients, 94 (29.9%) developed AKI after AAA repair
surgery. Severity of AKI and ruptured AAA were independently associated with an
increase in in-hospital mortality in AKI patients after AAA repair. Kaplan-Meier
analysis identified severity of AKI as being negatively associated with hospital
survival in AKI patients. Risk factors associated with AKI included
cardiovascular disease (OR 3.169, 95% confidence interval (CI) 1.538 to 6.527,
P = 0.002), decreased eGFR (OR 0.965, 95%CI 0.954 to 0.977, P < 0.001), ruptured
AAA (OR 2.717, 95%CI 1.320 to 5.592, P = 0.007), renal artery involvement (OR
2.903, 95%CI 1.219 to 6.912, P = 0.016) and OPEN (OR 2.094, 95%CI 1.048 to 4.183,
P = 0.036). Further subgroup analysis identified OPEN as an important risk factor
of AKI in ruptured AAA patients but not in ruptured AAA patients. The incidence
of AKI was significantly lower in EVAR than in OPEN (27.1% vs. 42.8%) and,
similarly lower in nonruptured AAA than in ruptured AAA (26.2% vs. 48.1%).
CONCLUSION: One-third of AAA patients developed AKI after repair surgery.
Severity of AKI was associated with reduced survival rate in AAA patients who
developed postoperative AKI. Decreased preoperative creatinine clearance,
cardiovascular disease, ruptured AAA and OPEN were independent risk factors for
postoperative AKI in all 314 AAA patients. Although a lower rate of incident AKI
was observed in EVAR compared with OPEN, subgroup analysis of ruptured AAA versus
nonruptured AAA showed that EVAR was an independent protective factor for AKI
only in ruptured AAA patients but not in nonruptured AAA patients.