Renal function-adjusted contrast medium volume is a major risk factor in the occurrence of acute kidney injury after endovascular aneurysm repair

Abstract

Acute kidney injury (AKI) is a complication that can occur during endovascular aneurysm repair (EVAR), increasing postoperative mortality and disease-related death. We therefore evaluated the incidence of AKI after elective EVAR, as well as related factors affecting AKI occurrence, investigating the volume of contrast medium (CV)/estimated glomerular filtration rate (eGFR) ratio as a predictive factor. We retrospectively reviewed the data of patients who underwent EVAR for infrarenal abdominal aorta aneurysm at a single center between April 2011 and December 2018. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. We evaluated the occurrence of AKI within the first 7 days postoperatively, comparing serum creatinine levels, eGFR, CV, CV/eGFR ratio, fluid input and output, and morbidity between the AKI and no-AKI groups. The data of 147 patients were analyzed, of which 131 (89.1%) were males (mean age: 72.10±7.40 years); the incidence of AKI was 4.1% (6/147 patients). The mean dose of contrast agents used was greater in the AKI group than in the no-AKI group (249.17 ± 83.21 mL vs 179.43 ± 84.32 mL, respectively; P = .05). The baseline eGFR was 42.69 ± 22.08 mL/kg/1.73 m 2 in the AKI group and 77.96 ± 18.92 mL/kg/1.73 m 2 in the no-AKI group ( P = .001). The CV/eGFR ratio was significantly higher in the AKI group (8.21 ± 6.13 vs 2.46 ± 1.44; P = 0.003). Baseline eGFR (odds ratio [OR] = 0.922, P = .001) and the CV/eGFR ratio (OR = 2.049, P = .008) were observed to be factors related to the occurrence of AKI in the logistic regression analysis for patients’ characteristics, operation-related factors, and renal outcomes. In the receiver operating characteristic curve analysis, the area under the curve of the CV/eGFR ratio was 0.856, indicating the greatest influence. A CV/eGFR ratio cutoff value of 3.84 was considered the most appropriate, with an 83.3% sensitivity and 83.0% specificity. The CV/eGFR ratio, rather than the absolute amount of contrast agents, was associated with the development of AKI after EVAR. The CV/eGFR ratio could be used as a possible indicator to limit the amount of contrast media required for the procedure.

Kidney Function, Male Gender, and Aneurysm Diameter Are Predictors of Acute Kidney Injury in Patients with Abdominal Aortic Aneurysms Treated Endovascularly

“…It is well recognized that contrast media can result in renal vasoconstriction, hypoxia damage, and acute tubular necrosis. [ 23 , 24 ] Contrast volume between patients who developed PC-AKI (179.3cc) versus patients who did not develop AKI (142.1cc) was much less dispersed compared with Mun et al [ 25 ] in whose study it was 249.17cc in PC-AKI patients and 179.43cc in non-PC-AKI patients. Although the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial demonstrated that post Hosmer-Lemeshow operative changes in SCr were comparable with no statistical differences in the incidence of AKI (as per their definition) or need for dialysis, [ 26 ] this study significantly demonstrates that adequate patient preparation prior to the procedure as well as management perioperatively aid in the prevention of PC-AKI.…”

A simplified acute kidney injury predictor following endovascular aortic repair: ACEF score

“…Chen et al 8 The effect of contrast volume on development of acute kidney injury in EVAR patients is controversial. While Sailer et al reported that iodinated contrast volume is not an independent risk factor for both AKI of long-term worsening for renal function 16 ; Jin Ho-Mun et al 17 reported contrast medium volume is a major risk factor in occurrence of AKI after endovascular repair. But still, the amount of contrast volume used in the EVAR procedure cannot predict AKI apart from demographical and clinical characteristics.…”

Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers increases the risk of postoperative acute kidney injury after elective endovascular abdominal aortic aneurysm repair

“…Most previous studies have reported similar results, showing that contrast load is not an independent risk factor for postoperative AKI. [22][23][24][25] Thus, the effect of contrast administration is still unclear.…”

“…[ 13 , 22 ] However, in previous studies, serum creatinine was not associated with postoperative AKI, and it was not clear whether baseline eGFR was related to postoperative AKI. Some studies have suggested that there is a significant association between baseline eGFR and postoperative AKI, [ 22 , 23 ] while others have suggested that there is no significant association [ 24 , 25 ] .…”