Acute kidney injury defined according to the ‘Risk,’ ‘Injury,’ ‘Failure,’ ‘Loss,’ and ‘End-stage’ (RIFLE) criteria after repair for a ruptured abdominal aortic aneurysm

Beek, S.C. van; Legemate, Dink A.; Vahl, A.C.; Bouman, Catherine S. C.; Vogt, Liffert; Wisselink, Willem; Balm, Ron

doi:10.1016/j.jvs.2014.04.072

Cited by 25 publications

(24 citation statements)

References 34 publications

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“…However, the outcomes of these studies are inconsistent. The Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) classification by the Acute Dialysis Quality Initiative group, or the Acute Kidney Injury Network (AKIN) criteria, has been used in most published studies, but results have been conflicting [3–5]. In 2012, the Kidney Disease Improving Global Outcomes (KDIGO) guideline writing group of the International Society of Nephrology proposed a new AKI criteria by combining AKIN, which has high sensitivity, with the well-stratified RIFLE [6].…”

Section: Introductionmentioning

confidence: 99%

The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after abdominal aortic aneurysm repair surgery

et al. 2017

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BackgroundAcute 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.MethodsA 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.ResultsAmong 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%).ConclusionOne-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.

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Section: Introductionmentioning

confidence: 99%

The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after abdominal aortic aneurysm repair surgery

et al. 2017

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“…It also looks at whether there are differences in morbidity rates for patients treated at the weekend or out of hours in more detail than existing work – an important consideration given the high rates of morbidity experienced by this patient population14 15. The mortality rate for patients with ruptured aneurysms in this data set was 37·1 per cent, which is in line with figures from the recent IMPROVE study10, an RCT comparing endovascular and open repair strategies for ruptured AAA, giving confidence that outcomes are in line with other published figures from a UK cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Patients treated acutely for AAA also experience significant morbidity, as highlighted by recent reports14 15 focusing on acute kidney injury after ruptured AAA repair. Assessments of differences in morbidity rates for patients treated at the weekend are notably absent from previous studies, perhaps because the large administrative databases used tend not to record these outcomes.…”

Section: Introductionmentioning

confidence: 99%

Weekend effect in non-elective abdominal aortic aneurysm repair

et al. 2017

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BackgroundThe ‘weekend effect’ describes the phenomenon where patient outcomes appear worse for those admitted at the weekend. It has been used recently to justify significant changes in UK health policy. Recent evidence has suggested that the effect may be due to a combination of inadequate correction for confounding factors and inaccurate coding. The effects of these factors were investigated in patients with acute abdominal aortic aneurysm (AAA).MethodsPatients undergoing non‐elective AAA repair entered into the UK National Vascular Registry from January 2013 until December 2015 were included in a case–control study. The patients were divided according to whether they were treated during the week (Monday 08.00 hours to Friday 17.00 hours) or at the weekend. Data extracted included demographics, co‐morbidities, preoperative medications and baseline blood test results, as well as outcomes. Coding issues were investigated by looking at patients treated for ruptured, symptomatic or asymptomatic AAA within the non‐elective cohort. The primary outcome was in‐hospital mortality. Secondary outcomes included length of inpatient stay, and cardiac, respiratory and renal complications.ResultsThe mortality rate appeared to be higher at the weekend (odds ratio (OR) 1·69, 95 per cent c.i. 1·47 to 1·94; P < 0·001), but this effect disappeared when confounding factors and coding issues were corrected for (corrected OR for ruptured AAA 1·09, 0·92 to 1·29; P = 0·330). Differences in outcomes were similar for prolonged length of hospital stay (uncorrected OR 1·21, 95 per cent c.i. 1·06 to 1·37, P = 0·005; corrected OR for ruptured AAA 1·06, 0·91 to 1·10, P = 0·478), and morbidity outcomes.ConclusionAfter appropriate correction for confounding factors and coding effects, there was no evidence of a significant weekend effect in the treatment of non‐elective AAA in the UK.

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“…[7][8][9][10] With the emergence of consensus criteria to standardize the definition of this postoperative complication, especially with mild and moderate degrees of AKI, recent studies within the vascular literature have demonstrated that AKI prevalence ranges from 13%-76% and is associated with adverse perioperative outcomes. [11][12][13][14] Many of these studies have focused on the prevalence of AKI after a specific procedure using small patient cohorts.…”

Section: Introductionmentioning

confidence: 99%

Mortality and Cost of Acute and Chronic Kidney Disease After Vascular Surgery

Huber¹,

Ozrazgat-Baslanti²,

Thottakkara³

2016

Journal of Vascular Surgery

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Introduction-Both acute kidney injury (AKI) and chronic kidney disease (CKD) are common yet underappreciated risk factors for adverse perioperative outcomes. We hypothesize that AKI and CKD are associated with similar increases in ninety-day mortality and cost in patients undergoing major vascular surgery.Methods-We used multivariable regression analyses to evaluate the associations between acute and chronic kidney disease and incremental ninety-day mortality and hospital cost in a singlecenter cohort of 3,646 adult patients undergoing major vascular surgery. We defined AKI using KDIGO (Kidney Disease: Improving Global Outcomes) criteria as change in creatinine ≥ 0.3 mg/dl or ≥50% increase from the reference value. CKD was determined from medical history. Regression models were adjusted for demographic and socio-economic characteristics, comorbid conditions, surgery type, and postoperative complications.Results-The prevalence of kidney disease among vascular surgery patients is high with 49% of patients developing AKI during hospitalization and 17% presenting with CKD on admission. In risk-adjusted logistic regression analysis, perioperative AKI (OR 2.2, 95% CI 1.5-3.3) was the most significant predictor of ninety-day mortality. The risk-adjusted average cost was significantly higher for patients with any type of kidney disease. The incremental cost of having any type of kidney disease ranged from $9,100 to $19,100, even after adjustment for underlying comorbidities and other postoperative complications. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusions-Kidney disease after major vascular surgery is associated with significant increase in ninety-day mortality and cost with the highest risk observed among patients with AKI regardless of previous CKD.

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Acute kidney injury defined according to the ‘Risk,’ ‘Injury,’ ‘Failure,’ ‘Loss,’ and ‘End-stage’ (RIFLE) criteria after repair for a ruptured abdominal aortic aneurysm

Cited by 25 publications

References 34 publications

The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after abdominal aortic aneurysm repair surgery

The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after abdominal aortic aneurysm repair surgery

Weekend effect in non-elective abdominal aortic aneurysm repair

Mortality and Cost of Acute and Chronic Kidney Disease After Vascular Surgery

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