Risk factors and outcomes associated with acute kidney injury following ruptured abdominal aortic aneurysm

Abstract

BackgroundCurrent data describing the epidemiology of acute kidney injury (AKI) following repair of ruptured abdominal aortic aneurysm (rAAA) are limited and long-term outcomes are largely unknown. Our objectives were to describe the incidence rate, risk factors, clinical course and long-term outcomes of AKI following rAAA repair.MethodsRetrospective population-based cohort study of all referrals undergoing emergency repair of rAAA in Northern Alberta from January 1, 2002 to December 31 2009. Demographic, clinical, physiologic and laboratory data were extracted. AKI was defined and classified according to the AKIN criteria.ResultsIn total, 140 patients survived to receive emergent rAAA repair. Post-operative AKI occurred in 75.7% of patients (n = 106), 78.3% (n = 83) of which occurred during the initial 24 hours of ICU admission. AKIN stage 1, 2, and 3 occurred in 47 (33.6%), 36 (25.7%) and 23 (16.4%), respectively, with 19 patients receiving renal replacement therapy (RRT). Several clinical and biochemical patient factors were associated with incident AKI, including baseline estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 (odds ratio [OR] 2.94; 95% CI, 1.15-7.51, p = 0.03), need for mechanical ventilation (OR 22.7; 95% CI, 7.0-72.1, p < 0.0001) and vasoactive therapy (OR 9.9; 95% CI, 3.0-32.2, p < 0.0001) and higher mean APACHE II scores (25.7 [8.2] vs. 16.3 [4.9], p < 0.0001). AKI was associated with a higher ICU (28.3% vs. 0%; p = 0.0008) and in-hospital case-fatality rate (35.9% vs. 0%, p = 0.0001). Of 102 survivors to discharge, 65.7% (n = 67) recovered to baseline kidney function. In multivariable analysis, greater severity of AKI (OR 5.01; 95% CI, 2.34-10.7, p < 0.001) and lower baseline eGFR (OR 0.96; 95% CI, 0.93-0.99, p = 0.03) were associated with non-recovery. AKI remained independently associated with 1-year mortality after adjusting for age, sex, comorbidity, and illness severity (OR 5.21; 95% CI, 1.04-26.2, p = 0.045; AUC 0.83; H-L GoF, p = 0.26). Among survivors at 1-year, only 63.4% (n = 55) had complete kidney recovery.ConclusionsFollowing rAAA repair, AKI is a common complication independently associated with long-term post-operative mortality. A significant proportion of AKI sufferers in this setting fail to recover to baseline kidney function.

Recovery from AKI in the critically ill: potential confounders in the evaluation

“…Since mortality increases with increasing AKI severity, exclusion of non-survivors mainly affects the recovery pattern of more severe forms of AKI. Worsening renal recovery with increasing severity of AKI confirms previous findings [4,11,15,19,20] and underscores the importance of clearly reporting AKI severity, including the need for RRT in stage 3.…”

“…The available reports used definitions based on absence of RIFLE criteria [4,17,24], return to baseline serum creatinine (Screat) [11,19,27], or a discharge Screat that returned to a value below 1.1 or 1.25 times baseline [7,10,16,20]. Few studies reported recovery according to AKI severity [4,11,15] and none of these studies used the KDIGO criteria [28] for both diagnosis of AKI and for assessment of recovery.…”

“…The majority of the available studies reported recovery at hospital discharge [17,[19][20][21][22][23][24][25]. With the exception of studies focusing on long-term follow-up [4,5,10], recovery is mostly reported for all AKI patients (survivors and non-survivors) [15,16,18,19,[21][22][23]26].…”

Supraceliac Aortic Clamping for Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Short Aortic Neck Length

“…Postoperative renal dysfunction is the most common complication of aneurysm repair requiring SC aortic clamping [14] [16] [17], and is associated with not only increased in-hospital morbidity and mortality but also adverse long-term outcomes [18] [19]. The effects of renal ischemic time and clamping level on postoperative renal function have been primarily examined in non-ruptured pararenal AAAs.…”

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

“…[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.…”