Early Postoperative Renal Dysfunction Predicts Long-Term Renal Function Degradation after Type IV Thoracoabdominal Aortic Aneurysm Surgical Repair

Rouer, Martin; Monnot, Antoine; Bubenheim, Michael; Fuda, Michelangelo; Godier, Sylvie; Lebras, Marie; Thomas, Pascale; Benadiba, Laurent; Elleboode, B.; Plissonnier, Didier

doi:10.1016/j.avsg.2020.04.072

Cited by 6 publications

(2 citation statements)

References 38 publications

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“…Severe AKI requires the use of RRT, and is associated with an increased risk of early mortality [6][7][8] . Furthermore, approximately 8% of patients who develop AKI progress towards end-stage renal dysfunction and require life-long renal care [9][10][11] . To provide effective kidney protection requires an appreciation of the multifactorial nature of renal injury.…”

Section: Introductionmentioning

confidence: 99%

Kidney Protection During Surgery on the Thoracoabdominal Aorta: A Systematic Review

Bennett,

Shirley,

Wilm

et al. 2024

Preprint

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ObjectivesPost-operative acute kidney injury (AKI) is a common complication of surgery to repair the thoracoabdominal aorta, and is associated with increased risks of dialysis and early mortality. Perfusion techniques are routinely used during surgery to reduce renal injury. We conducted a systematic review of renal and mortality outcomes by perfusion technique, to evaluate their effectiveness in providing kidney protection.MethodsWe searched PubMed, Web of Science,ClinicalTrials.govand ClinicalTrialsRegister.EU to identify relevant studies published from 1995 to 2023. Included studies were quality assessed, and data extracted. Findings of the highest quality studies were used to synthesise a narrative discussion.Results44 studies were included in our analysis, featuring three systemic perfusion strategies: Left heart bypass (LHB; n=24), cardiopulmonary bypass with deep hypothermic circulatory arrest (DHCA; n=17), and partial cardiopulmonary bypass (pCPB; n=11). Three categories of selective renal perfusion (SRP) strategy were identified: Warm blood, cold blood and cold crystalloid. Our analysis found that operative mortality was 0-22.0% following LHB, 2.2-12.5% following DHCA and 0-42.1% following pCPB. The incidence of post-operative renal replacement therapy (RRT) was 0-40.0% following LHB, 0-13.8% following DHCA and 0-31.6% following pCPB.ConclusionsIntra-operative perfusion strategies can facilitate kidney protection through improved oxygenation or hypothermic preservation. Distal aortic perfusion (DAP), with LHB or pCPB, is associated with lower rates of dialysis and operative mortality than simple aortic cross clamping. Whilst DHCA is associated with low rates of AKI, its use has not been evaluated through high-quality research. For extensive aneurysm repairs, adjunctive SRP with cold blood or crystalloid fluids is shown to enhance kidney protection during DAP, whereas warm blood SRP is associated with increased rates of AKI and operative mortality. We identify the optimisation of warm blood SRP and the attenuation of intravascular haemolysis as urgent areas of research to address the problem of AKI.

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Section: Introductionmentioning

confidence: 99%

Kidney Protection During Surgery on the Thoracoabdominal Aorta: A Systematic Review

Bennett,

Shirley,

Wilm

et al. 2024

Preprint

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“…Moreover, other studies showed that patients, who suffered from an acute kidney injury after liver resection were at higher risk to develop a renal dysfunction within the following years [ 22 ]. Another study from the field of cardiac and thoracic surgery revealed that a postoperative temporary and persistent decrease of the renal function is more often associated with the development of chronic kidney disease in comparison with patients who did not have a postoperative decrease of renal function [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of perioperative blood transfusions on postoperative renal function and survival after resection of colorectal liver metastases

et al. 2022

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Background and aims Recent studies focusing on thoracic surgery suggest postoperative kidney injury depending on the amount of perioperative blood transfusions. Data investigating similar effects after resection of colorectal liver metastases (CRLM) are not available. Aim of this study was therefore to evaluate the influence of perioperative blood transfusions on postoperative renal function and survival after resection of CRLM. Methods Seven hundred twenty-seven cases of liver resection for CRLM were retrospectively analyzed. Renal function was measured via estimated glomerular filtration rate (eGFR) and a postoperative decline of ≥ 10% was considered substantial. Potential influences on postoperative kidney function were assessed using univariable and multivariable logistic regression analyses. Cox-regression analyses were performed to estimate the impact on overall survival (OS). Results Preoperative impaired kidney function (p = 0.001, OR 2.477) and transfusion of > 2 units of packed red blood cells (PRBC) (p = 0.046; OR 1.638) were independently associated with an increased risk for ≥ 10% loss of renal function. Neither a pre-existing renal impairment, nor the additional loss of renal function were associated with reduced survival. Chemotherapies in the context of primary colorectal cancer treatment (p = 0.002), age > 70 years at liver resection (p = 0.005), number (p = 0.001), and size of metastases > 50 mm (p = 0.018), duration of resection > 120 min (p = 0.006) and transfusions of > 2 units of PRBC (p = 0.039) showed a negative independent influence on OS. Conclusion The results demonstrate a negative impact of perioperative blood transfusions on the postoperative renal function and OS. Hence, efforts to reduce blood transfusions should be intensified.

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Determining Predictors of Long-term Renal Function Degradation after Aortic Aneurysm Surgical Repair: Methodological Issues Should be Emphasized

Xue

Cheng

Xue

et al. 2021

Annals of Vascular Surgery

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Early Postoperative Renal Dysfunction Predicts Long-Term Renal Function Degradation after Type IV Thoracoabdominal Aortic Aneurysm Surgical Repair

Cited by 6 publications

References 38 publications

Kidney Protection During Surgery on the Thoracoabdominal Aorta: A Systematic Review

Kidney Protection During Surgery on the Thoracoabdominal Aorta: A Systematic Review

Impact of perioperative blood transfusions on postoperative renal function and survival after resection of colorectal liver metastases

Determining Predictors of Long-term Renal Function Degradation after Aortic Aneurysm Surgical Repair: Methodological Issues Should be Emphasized

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