A systematic review and meta-analysis indicates underreporting of renal dysfunction following endovascular aneurysm repair

Abstract

Deterioration in renal function has been described after endovascular repair of abdominal aortic aneurysms (EVR). The aetiology is multifactorial and represents an important therapeutic target. A need exists to quantitatively summarise incidence and severity of renal dysfunction after EVR to allow better-informed attempts to preserve renal function and improve life expectancy. A systematic search was performed using Medline and Embase for renal function after EVR applying PRISMA statements. Univariate and multivariate random effects meta-analyses were performed to estimate pooled post-operative changes in serum creatinine and creatinine clearance at four time points after EVR: 0-7 days, 30 days/1 month, 1 month-1year and ≥1year. Clinically relevant deterioration in renal function was also estimated at ≥1year after EVR. 23 papers were identified for analysis. Pooled probability of clinically-relevant deterioration in renal function ≥1year was 18% (95% CI=14-23%,I²=82.5%). From univariate meta-analyses, serum creatinine increased after EVR by of 0.05mg/dL at 30 days/1month, 0.09mg/dL at 1 month to 1 year and 0.11mg/dL at ≥ 1 year (all p<0.05). Creatinine clearance reduced after EVR by 5.65 ml/min at 1 month-1 year and 6.58 ml/min at ≥1 year (both p<0.05). Renal failure after EVR is underreported and reporting standards are poorly followed. Clinically relevant deterioration in renal function is common and merits focussed attention to attenuate impact on long-term mortality.

Survival Following Endovascular Aneurysm Repair in the Octogenarian

“…Postoperative renal dysfunction is a significant complication following EVAR and represents the most common post-operative complication in patients under and over 80 years of age (8.4% vs 14.6%) [13,14]. These figures are higher than currently reported in the literature which may be due to underreporting in the literature and a lack of a standardized definition on the subject [14][15][16]. However, these complications did not translate into a higher 30-day mortality rate in octogenarian patients.…”

Endovascular aneurysm repair (EVAR)– and transcatheter aortic valve replacement (TAVR)–associated acute kidney injury

“…post-operative year is further supported by a meta-analysis which has shown that 18% of patients have developed "clinically important renal dysfunction" at 1 year (defined as rise in SCr>30% compared to baseline). 66 This meta-analysis has, however, not reported AKI incidence using standardised criteria and employed suboptimal measures of renal decline over the long-term. 67 In our series investigating long-term renal decline (at 5 years) after Table 2 lists all large recent studies that evaluated AKI in TAVR patients.…”

Long-Term Renal Function after Endovascular Aneurysm Repair

“…We recently demonstrated that patients undergoing elective EVAR are at significant risk of developing AKI, with a prevalence of 19% (8). A meta-analysis showed that 18% of patients undergoing EVAR will have a clinically significant increase in their serum creatinine (SCr) after 1 year (9). Previous studies have also demonstrated a greater decrease in eGFR for patients who undergo EVAR for the first year compared with the general population (6,10).…”