Incidence and predictors of early and delayed renal function decline after aortic aneurysm repair in the Vascular Quality Initiative database

• Published in: Journal of vascular surgery 2021-11, Vol.74 (5), p.1537-1547
• Main Authors: Novak, Zdenek, Zaky, Ahmed, Spangler, Emily L., McFarland, Graeme E., Tolwani, Ashita, Beck, Adam W.
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Acute Kidney Injury - physiopathology; Aged; Aged, 80 and over; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - epidemiology; Aortic Aneurysm - surgery; Aortic repair; Blood Vessel Prosthesis Implantation - adverse effects; Databases, Factual; Disease Progression; Endovascular Procedures - adverse effects; Female; Glomerular Filtration Rate; Humans; Incidence; Kidney - physiopathology; Male; Middle Aged; Mortality; Postoperative acute kidney injury; Registries; Renal function decline; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States - epidemiology
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2021.04.049

Postoperative acute kidney injury (AKI) may complicate both open and endovascular aortic aneurysm repair (EVAR) and is associated with substantial morbidity, mortality, and health care expense. We aim to evaluate the incidence of postoperative AKI and factors associated with its occurrence and the effects of postoperative AKI on long-term renal function and mortality after open and EVAR in the Society for Vascular Surgery Vascular Quality Initiative registry. Elective aneurysm cases were identified including thoracic endovascular aortic aneurysm repair (TEVAR) and complex endovascular aortic aneurysm repair (cEVAR), infrarenal endovascular repair (EVAR) and infrarenal open repair (OAR) from 2003 to 2019. The preoperative estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease formula and stratified based on chronic kidney disease (CKD) grades. Postoperative AKI was defined per the Vascular Quality Initiative definition as a creatinine increase of 0.5 mg/dL or if postoperative dialysis was required. Patients on preprocedural hemodialysis and those with previous renal transplant were excluded. Demographics and procedural factors were evaluated for predicting in-hospital postoperative AKI (all approaches) and at 9 to 21 months of long-term follow-up (EVAR only) using logistic regression modeling. We identified a total of 2813 cEVAR, 2995 TEVAR, 39,945 EVAR, and 8143 OAR patients. Of those, postoperative AKI occurred in 377 cEVAR (13.5%), 199 TEVAR (6.7%), 1099 EVAR (2.8%), and 1249 OAR (15.5%). Risk factors for postoperative AKI across all groups were worse preoperative eGFR, total number of blood transfusions, perioperative anemia, reinterventions, and postoperative respiratory complications. Additional procedure-specific risk factors of postoperative AKI were preoperative hemoglobin of less than 10 and contrast volume of 125 to 150 mL, hypertension, a low ejection fraction, and a history of percutaneous revascularization for EVAR; for both EVAR/cEVAR, renal artery coverage was a risk factor, whereas for OAR, male sex, non-White race, hypertension, suprarenal aortic cross-clamp, and increased renal ischemic time were risk factors. Among 8133 EVAR patients with long-term follow-up, a decrease in kidney function occurred in 56.7% of patients with postoperative AKI vs 19.9% without postoperative AKI (P < .001). The following risk factors were associated with a decrease in renal function at long-term follow-up: