Acute kidney injury after open and endovascular elective repair for infrarenal abdominal aortic aneurysms

Abstract

The aim of this study was to evaluate the incidence of acute kidney injury (AKI) after open and endovascular abdominal aortic aneurysm repair according to the Aneurysm Renal Injury Score classification. We retrospectively evaluated 431 patients undergoing elective open aortic repair (OAR; n= 285) or endovascular repair (n= 146) for infrarenal aortic aneurysm. All data regarding preoperative and postoperative serum creatinine concentrations and postoperative outcomes were assessed. Univariate and multivariate logistic regression models investigated the association between AKI and different risk factors and complications. The incidence of AKI was significantly higher after OAR (26.3% vs 5.5%; P< .001). A significant share of patients who experienced AKI were restored to preoperative renal function at discharge (62.5% vs 77.5% in the endovascular and OAR groups, respectively; P= .37). Preoperative serum creatinine concentration was significantly higher in those patients who further developed AKI (1.25 vs 1.04mg/dL; P< .001). At the multivariate analysis, AKI was significantly associated with current smoking (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.19-3.52; P= .01), hypertension (OR, 2.46; 95% CI, 1.21-4.3; P=.01), chronic renal disease (OR, 2.53; 95% CI, 1.42-4.53; P< .001), OAR (OR, 7.3; 95% CI, 3.25-16.42; P< .001), and arrhythmias (OR, 3.16; 95% CI, 1.09-9.13; P= .03). AKI stage did not affect postoperative outcomes, except for a longer hospital stay in patients in stage 2 and stage 3 compared with stage1. AKI is a common but often reversible complication, especially after OAR. There is an urgent need of a common classification for AKI after aortic surgery. New diagnostic markers for AKI should be evaluated in large-scale studies to assess their reliability.