Impact of Chronic Kidney Disease on Outcomes After Abdominal Aortic Aneurysm Repair

Abstract

Chronic kidney disease (CKD) is associated with increased morbidity and death after open abdominal aortic aneurysm (AAA) repair (OAR). This study highlights the effect of CKD on outcomes after endovascular AAA repair (EVAR) and OAR in contemporary practice. The National Surgical Quality Improvement Program Participant Use File (2005-2008) was queried by Current Procedural Terminology code to identify EVAR or OAR patients who were grouped by CKD class as having mild (class 1, 2), moderate (class 3), or severe (class 4, 5) renal disease. Comparative analysis of mortality and clinical outcomes was performed based on CKD strata. CKD increased (P < .01) overall mortality with rates of 1.7% (mild), 5.3% (moderate), and 7.7% (severe) in unmatched patients. Rates in severe patients were as high as 6.2% for EVAR and 10.3% for OAR. Propensity matching to control for comorbidities was performed, resulting in similar baseline clinical and demographic features of patients with mild compared to those with moderate or severe disease. Even in matched cohorts, moderate and severe CKD increased the risk of 30-day mortality and complications compared with mild OAR and EVAR patients (Table I). On regression analysis, moderate and severe CKD independently predicted operative mortality and complications (Table II).Table IThirty-day outcomes in propensity-matched open repair (OAR) and endovascular aneurysm repair (EVAR) patients by degree of chronic kidney disease (CKD)CKD degree30-day mortality (%)Any complication (%)EVAROAREVAROARMild1.93.13.111Moderate3.2aP ≤ .01 compared with mild CKD.8.4aP ≤ .01 compared with mild CKD.8.4aP ≤ .01 compared with mild CKD.32aP ≤ .01 compared with mild CKD.Severe5.7aP ≤ .01 compared with mild CKD.9.9aP ≤ .01 compared with mild CKD.9.9aP ≤ .01 compared with mild CKD.25aP ≤ .01 compared with mild CKD.a P ≤ .01 compared with mild CKD. Open table in a new tab Table IIChronic kidney disease (CKD) independently predicts mortality and complication riskCKD degree30-day mortalityAny complicationOR (95% CI)OR (95% CI)EVAROAREVAROARModerate1.7 (1.1-2.7)aP ≤ .05 compared with mild.2.8 (1.8-4.5)aP ≤ .05 compared with mild.1.6 (1.3-2.0)aP ≤ .05 compared with mild.1.4 (1.2-1.8)aP ≤ .05 compared with mild.Severe1.5 (1.1-2.1)aP ≤ .05 compared with mild.1.6 (1.1-2.3)aP ≤ .05 compared with mild.1.4 (1.2-1.7)aP ≤ .05 compared with mild.1.2 (1.01-1.4)aP ≤ .05 compared with mild.CI, Confidence interval; EVAR, endovascular aneurysm repair; OAR, open aneurysm repair; OR odds ratio.a P ≤ .05 compared with mild. Open table in a new tab CI, Confidence interval; EVAR, endovascular aneurysm repair; OAR, open aneurysm repair; OR odds ratio. The presence of moderate or severe CKD in patients considered for AAA repair is associated with significantly increased mortality and therefore should figure prominently in clinical decision making.