Editor's Choice - Acute Kidney Injury (AKI) in Aortic Intervention: Findings From the Midlands Aortic Renal Injury (MARI) Cohort Study.
Acute Kidney Injury
/ diagnosis
Age Factors
Aged
Aortic Aneurysm, Abdominal
/ surgery
Creatinine
Endovascular Procedures
/ adverse effects
Female
Glomerular Filtration Rate
/ physiology
Humans
Incidence
Kidney
/ physiopathology
Male
Postoperative Complications
/ diagnosis
Prospective Studies
Risk Assessment
Risk Factors
Acute kidney injury
Aorta
Cohort study
Endovascular
Vascular surgery
Journal
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
ISSN: 1532-2165
Titre abrégé: Eur J Vasc Endovasc Surg
Pays: England
ID NLM: 9512728
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
04
05
2019
revised:
10
09
2019
accepted:
25
09
2019
pubmed:
25
12
2019
medline:
25
6
2020
entrez:
25
12
2019
Statut:
ppublish
Résumé
The incidence of acute kidney injury (AKI) after open (OAR) or endovascular (EVAR) aortic repair is unknown. This research assessed the proportion of patients who develop AKI after aortic intervention using validated criteria, and explored AKI risk factors. This was a multicentre national prospective cohort study. Eleven centres recruited patients undergoing EVAR or OAR (September 2017-December 2018). Serum creatinine (SCr) and urine outputs were measured over a minimum of 48 h or throughout the index inpatient stay to define post-operative AKI using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Renal decline at 30 days was calculated using estimated glomerular filtration rate (eGFR) and the Major Adverse Kidney Events (MAKE) 30 day composite endpoint (consisting of: death, new dialysis, > 25% eGFR decline). 300 patients (mean age: 71 years, standard deviation [SD] 4 years; 9% females) were included, who underwent: infrarenal endovascular aneurysm repair (EVAR) 139 patients, fenestrated EVAR (fEVAR) 30, branched EVAR (bEVAR) seven, infrarenal open aneurysm repair (OAR) 98, juxtarenal OAR 26. Overall, 24% of patients developed stage 1 AKI (defined at 48 h as per KDIGO), 2.7% stage 2 AKI and 1% needed renal replacement therapy before discharge. AKI proportions per intervention were: infrarenal EVAR 18%; fEVAR 27%; bEVAR 71%; infrarenal OAR 41%; juxtarenal OAR 63%. Older age (odds ratio [OR] 1.44 for EVAR, 1.58 for OAR), lower baseline eGFR (OR 0.88 EVAR, 0.74 OAR), and ischaemic heart disease (OR 4.42 EVAR, 5.80 OAR) were the main predictors of AKI for infrarenal EVAR and OAR. Overall, 24% developed the MAKE30 endpoint. All patients who died (0.6%) or developed a major cardiac event (5.6%) at one year had developed AKI. AKI and short term renal decline after aortic intervention are common. Age, renal function, and cardiovascular disease are the main risk factors. Research should now focus on AKI prevention in this high risk group.
Identifiants
pubmed: 31870694
pii: S1078-5884(19)32021-0
doi: 10.1016/j.ejvs.2019.09.508
pii:
doi:
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
899-909Subventions
Organisme : Department of Health
ID : NIHR300059
Pays : United Kingdom
Investigateurs
David Sidloff
(D)
George Dovell
(G)
Rachael Forsythe
(R)
Loretta Barnett
(L)
Henrietta Barnet
(H)
Julie Wollaston
(J)
Stephen Goodyear
(S)
Asif Mahmood
(A)
Nicholas Matharu
(N)
Seamus Harrison
(S)
Jonathan Boyle
(J)
Emma Parker
(E)
Abigail Carlin
(A)
Mandy Burrows
(M)
Tristan Lane
(T)
Joseph Shalhoub
(J)
Andrew Garnham
(A)
Safia Begum
(S)
Phil Stather
(P)
Jessica Thrush
(J)
Terry Martin
(T)
Jack Fairhead
(J)
Julien Al Shakarchi
(J)
Tom Wallace
(T)
Elaine Wall
(E)
Christopher Twine
(C)
Wissam Al-Jundi
(W)
Huw Davies
(H)
Tom Barker
(T)
Edward Lopez
(E)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.