Predictors Of Postoperative Renal Dysfunction Research Articles

Effects of perirenal fat thickness on postoperative renal dysfunction in patients who underwent robot-assisted partial nephrectomy for renal tumours.

Despite partial nephrectomy (PN) renal function preservation benefits, postoperative renal dysfunction may occur. Perirenal fat thickness (PFT) is associated with renal dysfunction such as diabetes; however, its role in renal tumour surgery is unclear. This study investigates the role of PFT in renal function after robot-assisted partial nephrectomy (RAPN). Pre-operative factors for postoperative renal dysfunction were analysed in 156 patients undergoing RAPN with ≥1-year follow-up. PFT measured using computed tomography categorised patients with PFT >21.0mm (median) as high-PFT. Tumour size, total R.E.N.A.L. nephrometry score and its N component, renal calyx opening, achievement of trifecta, and PFT were risk factors for renal dysfunction 1year postoperatively. Age ≥75years (p=0.024), total RNS ≥7 (p=0.036), and PFT >21.0mm (p=0.002) significantly correlated with postoperative renal dysfunction. CT-measured PFT is a valuable predictor of postoperative renal dysfunction.

MP59-13 USEFULNESS OF THE MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTIVE FACTOR FOR RENAL DYSFUNCTION AFTER PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP59)1 Sep 2021MP59-13 USEFULNESS OF THE MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTIVE FACTOR FOR RENAL DYSFUNCTION AFTER PARTIAL NEPHRECTOMY Yu Endo, Yuki Yoshida, Yuta Matsuoka, Tomoyuki Koguchi, Junya Hata, Yuichi Sato, Hidenori Akaihata, Masao Kataoka, Soichiro Ogawa, and Yoshiyuki Kojima Yu EndoYu Endo More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Yuta MatsuokaYuta Matsuoka More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Junya HataJunya Hata More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Masao KataokaMasao Kataoka More articles by this author , Soichiro OgawaSoichiro Ogawa More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002094.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In partial nephrectomy(PN), both cancer control and the preservation of postoperative renal function are important goals. The relationship between perinephric fat and renal dysfunction has recently been attracting a great deal of attention. Therefore, we hypothesized that the PNF environment in the preoperative period might be associated with renal dysfunction after PN. In this study, whether the Mayo adhesive probability (MAP) score, an index of the perinephric fat environment, could be a predictive factor for renal dysfunction after partial nephrectomy was investigated. METHODS: A retrospective case-control study of 78 patients who underwent laparoscopic partial nephrectomy was performed. an estimated glomerular filtration rate preservation rate at <90% at 1 month after surgery was defined as postoperative renal dysfunction. These patients were devided into two groups (non-dysfunction and dysfunction groups). The MAP score is calculated algorithmically from two measures: posterior renal fat thickness and the extent of PNF stranding around the kidney at the level of the renal vein on computed tomography. Patient factors including MAP scores(both tumor and unaffected sides) and surgical factors were evaluated to identify the predictors for postoperative renal dysfunction. The statistical analysis used univariate and multivariate logistic regression analysis. RESULTS: Forty-one (52.6%) patients had postoperative renal dysfunction. Univariate analysis identified MAP score on the unaffected side (p<0.01), sex (p=0.04), hypertension (p=0.02), benign or malignant (p=0.04), operative time (p=0.01), and warm ischemia time (p=0.01) as predictors of postoperative renal dysfunction. On multivariate analysis, MAP score on the unaffected side (p=0.04; odds ratio 1.40[1.05-1.95]) and warm ischemia time (p=0.03; odds ratio 1.04 [1.01-1.08]) were significantly associated with postoperative renal dysfunction. On receive operating characteristic curve analysis, MAP score on the unaffected side (p<0.01; cutoff value 1.5) and warm ischemia time (p=0.01; cutoff value 26.5 min) were significant predictors of renal dysfunction 1 month after surgery. CONCLUSIONS: The MAP score on the unaffected side and warm ischemia time are useful predictors for renal dysfunction after partial nephrectomy. In particular, the deterioration of the PNF environment, which is indicated by a high MAP score, might be related to renal dysfunction after PN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1035-e1035 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yu Endo More articles by this author Yuki Yoshida More articles by this author Yuta Matsuoka More articles by this author Tomoyuki Koguchi More articles by this author Junya Hata More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Masao Kataoka More articles by this author Soichiro Ogawa More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement Loading ...

Predictors of Postoperative Renal Dysfunction and Durability of Open Repair of Juxtarenal Abdominal AorticAneurysms

Predictors of Postoperative Renal Dysfunction and Durability of Open Repair of Juxtarenal Abdominal AorticAneurysms

Renal dysfunction after abdominal or thoracic endovascular aortic aneurysm repair: incidence and risk factors.

To determine the incidence and risk factors of renal dysfunction after abdominal endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). The study consisted of 227 patients treated with EVAR and 90 with TEVAR for aortic aneurysms. Parameters, including patients' background factors, preoperative renal function, contrast dose and aortic wall irregularity on CT images were assessed in relation to postoperative renal dysfunction. Deterioration of renal function was observed in 33 of 218 patients (15.1%) after EVAR and in 7 of 79 (8.9%) patients after TEVAR. Hemodialysis was required in one patient after EVAR. In EVAR, renal dysfunction correlated with age (p=0.034) and occlusion of accessory renal artery (p=0.0001). In TEVAR, renal dysfunction correlated with age (p=0.021), contrast dose (p=0.042) and irregularity of the descending aortic wall (p=0.023). In a multiple regression analysis, postoperative renal dysfunction was correlated with occlusion of accessory renal artery (p=0.0003) after EVAR, and age (p=0.02), contrast dose (p=0.026) and irregularity of the descending aortic wall (p=0.042) after TEVAR. Occlusion of accessory renal artery in EVAR, and age, contrast dose and irregularity of the descending aortic wall in TEVAR were considered to be predictors of postoperative renal dysfunction.

Existence of renal dysfunction in diabetics undergoing coronary artery bypass.

The effect of diabetes mellitus on morbidity and mortality in patients undergoing coronary artery bypass grafting has remained uncertain, and conflicting conclusions have been reported in clinical trials. Evidence suggests that coronary artery bypass in patients with diabetes mellitus carries a higher risk of stroke, renal failure, perioperative complications, and sternal wound infection. This study evaluated the frequency of acute renal dysfunction after coronary artery bypass in diabetic patients, and the associated risk factors. This cross-sectional observational study included 135 patients with diabetes (111 males and 24 females with a mean age 51 years and a body mass index of 27.44 kg m(-2)), who underwent elective coronary artery bypass from March 2015 to October 2015. Data were collected prospectively in 2 tertiary care centers. Renal dysfunction was assessed by serum creatinine levels preoperatively and at 24 and 48 h postoperatively. Fifteen percent of patients were found to have postoperative renal dysfunction. Univariate analysis revealed that patients with increased serum creatinine preoperatively were at greater risk of developing renal dysfunction after coronary artery bypass (p = 0.00). On multivariable binary logistic regression analysis, preoperative serum creatinine level was the only independent predictor of postoperative renal dysfunction; age, body mass index, dyslipidemia, hypertension, cardiopulmonary bypass time, and aortic crossclamp time showed no significant association. Diabetic patients with increased serum creatinine preoperatively are at greater risk of kidney damage postoperatively; therefore, these patients should be monitored and treated critically in the perioperative period.

Cystatin C as a predictive marker of renal dysfunction and mid-term outcomes following off-pump coronary artery bypass grafting

ObjectiveTo determine whether plasma cystatin C and creatinine levels after isolated off-pump coronary artery bypass grafting (OPCAB) are predictive of postoperative renal dysfunction and clinical outcomes.MethodsBetween January 2008 and December...

Technical factors are strongest predictors of postoperative renal dysfunction after open transperitoneal juxtarenal abdominal aortic aneurysm repair

Juxtarenal abdominal aortic aneurysms (AAAs) have predominantly been repaired using an open technique. We present a series of patients with juxtarenal AAAs and analyze multiple factors predictive of postoperative renal dysfunction. Between March 2000 and September 2011, all patients in our prospectively maintained database undergoing juxtarenal AAA repair were evaluated for demographics, operative details, and in-hospital outcomes. Postoperative renal dysfunction was classified using the RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria (glomerular filtration rate decrease >25%). The relationship between perioperative factors and postoperative renal dysfunction was explored using both univariate and multivariate analysis (logistic regression). Of 169 patients, 76 (45%) required clamping above one renal artery, whereas 93 patients (55%) required clamping above both renal arteries. Mean (standard deviation) renal ischemia time was 29.2 (8.9) minutes (range, 12-65 minutes). Twenty-seven patients (16%) underwent adjunctive renal procedures, 19 (11.3%) required left renal vein division, and 130 (76.9%) received intraoperative mannitol. Postoperative renal dysfunction occurred in 63 patients (37.3%), with the majority (69%) resolving during hospital stay. Seven patients (4.1%) required postoperative dialysis, which was permanent in two cases. Patients who developed postoperative renal dysfunction had significantly longer mean renal ischemia times (34.7 [9.3] minutes vs 25.9 [6.6] minutes; P < .001), a higher rate of bilateral suprarenal aortic clamping (68.3% vs 47.2%; P = .008), higher rates of adjunctive renal artery procedures (26.7% vs 8.8%; P = .002), and higher rates of left renal vein division (20.6% vs 5.7%; P = .003). Logistic regression identified left renal vein division, renal ischemia time, and aortic clamp position as the strongest predictors of renal dysfunction. The use of mannitol was seen to be protective. Overall in-hospital mortality was 4.1% and was 9.5% among patients with postoperative renal dysfunction. Postoperative transient renal dysfunction occurred in 37.3% of patients after open juxtarenal AAA repair, with a low incidence of dialysis and a low rate of permanent dysfunction. Technical factors including renal ischemia time, aortic clamp position, and left renal vein division are the strongest predictors of renal dysfunction. The use of intraoperative mannitol was associated with decreased postoperative renal dysfunction.

Beyond Serum Creatinine: Creatinine Clearance is a Better Predictor of Postoperative Renal Dysfunction, and Outcomes Following Cardiopulmonary Bypass

Beyond Serum Creatinine: Creatinine Clearance is a Better Predictor of Postoperative Renal Dysfunction, and Outcomes Following Cardiopulmonary Bypass

Postoperative renal function preservation with nonischemic femoral arterial cannulation for thoracoabdominal aortic repair

Renal failure after thoracoabdominal aortic repair is a significant clinical problem. Distal aortic perfusion for organ and spinal cord protection requires cannulation of the left femoral artery. In 2006, we reported the finding that direct cannulation led to leg ischemia in some patients and was associated with increased renal failure. After this finding, we modified our perfusion technique to eliminate leg ischemia from cannulation. In this article, we present the effects of this change on postoperative renal function. Between February 1991 and July 2008, we repaired 1464 thoracoabdominal aortic aneurysms. Distal aortic perfusion was used in 1088, and these were studied. Median patient age was 68 years, and 378 (35%) were women. In September 2006, we began to adopt a sidearm femoral cannulation technique that provides distal aortic perfusion while maintaining downstream flow to the leg. This was used in 167 patients (15%). We measured the joint effects of preoperative glomerular filtration rate (GFR) and cannulation technique on the highest postoperative creatinine level, postoperative renal failure, and death. Analysis was by multiple linear or logistic regression with interaction. The preoperative GFR was the strongest predictor of postoperative renal dysfunction and death. No significant main effects of sidearm cannulation were noted. For peak creatinine level and postoperative renal failure, however, strong interactions between preoperative GFR and sidearm cannulation were present, resulting in reductions of postoperative renal complications of 15% to 20% when GFR was <60 mL/min/1.73 m(2). For normal GFR, the effect was negated or even reversed at very high levels of GFR. Mortality, although not significantly affected by sidearm cannulation, showed a similar trend to the renal outcomes. Use of sidearm cannulation is associated with a clinically important and highly statistically significant reduction in postoperative renal complications in patients with a low GFR. Reduced renal effect of skeletal muscle ischemia is the proposed mechanism. Effects among patients with good preoperative renal function are less clear. A randomized trial is needed.

The Impact of Aprotinin on Postoperative Renal Dysfunction in Neonates Undergoing Cardiopulmonary Bypass: A Retrospective Analysis

Recent concern about the safety of aprotinin administration to adults has led to its suspension from worldwide markets. However, few studies have examined its safety in pediatric patients. Studies in children evaluating aprotinin's safety have been hindered by the heterogeneity of pediatric patients and the inconsistency of clinical protocols. In this investigation, we retrospectively reviewed 200 neonatal cardiac surgical cases performed at our institution to examine the safety of aprotinin, focusing on postoperative renal dysfunction, using a consistent aprotinin dosing protocol. Two-hundred consecutive neonates scheduled for palliative or corrective congenital cardiac surgery requiring cardiopulmonary bypass (CPB) from January 1, 2005 through February 28, 2007 were included in this retrospective investigation. Preoperative, intraoperative and postoperative data were collected and analyzed. Markers of safety included 72-h postoperative renal dysfunction, need for dialysis (peritoneal or hemodialysis), thrombosis and in-hospital mortality. Neonates were divided into those who received aprotinin (aprotinin group; n = 156) and those who did not (no aprotinin group; n = 44). Twenty-four and 72-h postoperative serum creatinine levels were significantly greater than baseline levels in both groups. The degree of change in creatinine levels was highly significant and similar between the two groups. A larger percentage of neonates in the aprotinin group developed renal dysfunction, although this difference was not statistically significant. Stepwise logistic regression, assessing the impact on renal dysfunction of all variables that indicated significance between neonates who did or did not receive aprotinin and between neonates who did or did not develop renal dysfunction, identified CPB time and age as significant predictors of postoperative renal dysfunction. All neonates who developed postoperative renal dysfunction had a CPB time of more than 100 min regardless of the use of aprotinin. Additionally, using this subset, similar percentages of renal dysfunction occurred in both groups. A second multivariable regression analysis to simultaneously account for the predictors of CPB time, age and aprotinin administration found CPB time to be the only significant predictor of renal dysfunction. Incidences of postoperative dialysis, postoperative thrombosis and in-hospital mortality were not statistically significantly different between the aprotinin and the no aprotinin groups. The occurrence of postoperative renal dysfunction in neonates was more significantly predicted by the duration of CPB than by the intraoperative administration of aprotinin. CPB times of more than 100 min appeared to be a critical marker for the development of postoperative renal dysfunction. Randomized prospective trials are needed to confirm the validity of our retrospective findings.

Renal Dysfunction in High-Risk Patients After On-Pump and Off-Pump Coronary Artery Bypass Surgery: A Propensity Score Analysis

Cardiopulmonary bypass may be a causal factor in the development of renal impairment after cardiac surgery. When acute renal failure requiring dialysis occurs after cardiac surgery, it is associated with high mortality. We attempted to determine whether off-pump coronary artery bypass grafting surgery prevents postoperative renal dysfunction in patients at high risk for renal failure. Retrospective analysis identified 2,869 patients who had preexisting renal dysfunction (preoperative creatinine clearance less than 60 mL/min) and who underwent isolated coronary artery bypass grafting between 1995 and 2003. Patients who required preoperative dialysis were excluded. Propensity scores were computed to match off-pump coronary artery bypass surgery patients 3:1 with those who underwent conventional coronary artery bypass grafting surgery, and the independent predictors of postoperative renal dysfunction were determined. Two thousand seven hundred eleven patients with preexisting renal dysfunction underwent conventional coronary artery bypass grafting surgery, and 158 patients underwent coronary artery bypass grafting surgery without cardiopulmonary bypass (off-pump coronary artery bypass grafting surgery group). The matched groups showed no differences in any of the preoperative or postoperative variables examined. Diabetes (odds ratio, 1.96; p = 0.01), peripheral vascular disease (odds ratio, 2.50; p < 0.001), and reduced preoperative creatinine clearance (odds ratio, 1.02; p = 0.02) were independent risk factors for the development of postoperative renal dysfunction. Off-pump coronary artery bypass grafting surgery was not associated with a decreased risk of renal dysfunction by univariate or multivariable analysis. Off-pump coronary artery bypass grafting surgery did not reduce the risk of postoperative renal dysfunction in this large, unselected, sequential series of patients at high risk for renal failure after coronary artery bypass grafting surgery. Our results suggest that renal function should not be a deciding factor when determining whether or not a patient undergoes off-pump coronary artery bypass grafting surgery.

Preventing Renal Failure in Thoracoabdominal Aortic Aneurysm Repair

In our cumulative experience of 1004 thoracoabdominal and descending thoracic aortic aneurysm repairs, approximately 20% of patients have suffered from some form of postoperative renal dysfunction. Although slightly lower than rates in the era of cross-clamp-and-go, the contemporary incidence of renal failure and consequent morbidity and mortality remain significant. Between January 1991 and February 2003, we used and appraised many different forms of renal protection. After September 1992, we began to routinely use the adjuncts of distal aortic perfusion and cerebrospinal fluid drainage for all thoracoabdominal and descending thoracic aortic aneurysm repairs. The methods we examined for renal protection included aortic perfusion, followed by warm blood visceral perfusion, antegrade cold blood visceral perfusion, retrograde cold blood perfusion, and the perioperative use of a renal protective pharmacologic agent, fenoldopam. The results were not overly promising. We are currently testing a method of split perfusion in which the renal arteries receive cold lactated Ringer's solution while the visceral arteries are perfused with cold blood. The major predictors of postoperative renal dysfunction are preoperative renal function, cross-clamp time, and repair extending to the renal arteries. Distal aortic perfusion is protective, but only for aortic repair that does not directly involve the renal arteries. Evidence shows that patients with cold perfusion have superior survival and recovery rates, but none of the adjuncts clearly prevent acute renal failure. The current mortality rates associated with postoperative renal failure remain high, and the pursuit of the optimal method of renal protection is a top priority.

Atherosclerosis of the ascending aorta is a predictor of renal dysfunction after cardiac operations

Objectives: Renal dysfunction occurring after cardiac operations has been attributed to various factors, but the importance of an atherosclerotic thoracic aorta has not been previously evaluated. The purpose of this study was to identify predictors of postoperative renal dysfunction (50% or more increase from preoperative values) and to evaluate the importance of atherosclerosis of the ascending aorta as a predictor of this complication. Methods: Nine hundred seventy-eight consecutive patients, 50 years of age and older with normal preoperative renal function (serum creatinine level of 1.5 mg/dL or less), who were scheduled to undergo cardiac surgery were prospectively evaluated. Atherosclerosis of the ascending aorta was assessed during the operation (with epiaortic ultrasound), and patients were divided into 3 groups according to its severity (normal-to-mild, moderate, and severe). Results: Univariate predictors of renal dysfunction at postoperative day 1 were atherosclerosis of the ascending aorta ( P < .045) and postoperative low cardiac output ( P = .05); at postoperative day 6 they were atherosclerosis of the ascending aorta ( P < .0001), postoperative low cardiac output ( P < .0001), advanced age ( P = .001), decreased preoperative left ventricular function ( P = .01), and female gender ( P = .03). Multivariate analysis showed that atherosclerosis of the ascending aorta (odds ratio, 3.06; P = .04) was the only independent predictor of postoperative renal dysfunction at day 1 and that postoperative low cardiac output (odds ratio, 4.83; P < .0001), atherosclerosis of the ascending aorta (odds ratio, 2.13; P = .0006), and preoperative left ventricular dysfunction (odds ratio, 1.48; P = .028) were independent predictors of postoperative renal dysfunction at day 6. Conclusions: An atherosclerotic ascending aorta is an important predictor of postoperative renal dysfunction, possibly because atheroembolism to the kidneys occurs in the perioperative period (ie, during surgical manipulation of an atherosclerotic aorta) or because the diseased aorta may be a marker of widespread atherosclerotic disease that may predispose to perioperative renal dysfunction. (J Thorac Cardiovasc Surg 1999;117:111-6)

Role of perfusion pressure and flow in major organ dysfunction after cardiopulmonary bypass

The role of perfusion pressure and flow during cardiopulmonary bypass with moderate hypothermia and hemodilution in the development of new postoperative renal or clinically apparent cerebral dysfunction was examined in 504 adults. Cardiopulmonary bypass flow was targeted at greater than 40 mL · kg −1 · min −1 and pressure at greater than 50 mm Hg. Flows and pressures less than target occurred in 21.6% and 97.1% of patients, respectively. Fifteen patients (3.0%) suffered new renal and 13 (2.6%) new central nervous system dysfunction. Low pressure or flow during cardiopulmonary bypass, expressed in absolute values or in intensity-duration units, were not predictors of either adverse outcome. Multivariate analysis identified use of postoperative intraaortic balloon counterpulsation ( p < 10 −6), excessive blood loss in the ICU ( p < 10 −4), need for vasopressors before cardiopulmonary bypass ( p < 10 −4), postoperative myocardial infarction ( p < 10 −3), emergency reoperation ( p < 0.002), excessive postoperative transfusion ( p < 0.02), and chronic renal disease ( p < 0.03) as independent predictors of postoperative renal dysfunction. Independent predictors of postoperative central nervous system dysfunction were cardiopulmonary resuscitation in the intensive care unit ( p < 10 −6), intracardiac thrombus or valve calcification ( p < 0.02), and chronic renal disease ( p < 0.03). Age greater than 65 years (40.7% of patients) did not predict either outcome. We conclude that failure of the native circulation during periods other than cardiopulmonary bypass rather than the flows and pressures considered here is the major cause of renal and clinically apparent central nervous system dysfunction after cardiac operations.

Increased complications and prolonged hospital stay in elderly cardiac surgical patients with low serum albumin

Cardiac surgery in elderly patients is associated with acceptable operative mortality but an increased complication rate. Malnutrition is common in the elderly and may adversely affect surgical outcome. To determine the effect of hypoalbuminemia on postoperative complications, 92 patients ≥75 years (range 75 to 90) undergoing a variety of major cardiac surgical procedures were evaluated. Thirteen patients (14%) had a serum albumin level <3.5 g/dl preoperatively. Compared to patients with normal albumin, hypoalbuminemic patients had an increased frequency of postoperative confusion, congestive heart failure, low cardiac output, renal dysfunction and gastrointestinal complications (all p < 0.05). Mean postoperative length of stay was markedly prolonged in these patients (27 vs 12 days; p < 0.001), and mortality also tended to be higher (31 vs 13%; p = 0.11). Using multivariate analysis, albumin <3.5 g/dl was the most powerful predictor of postoperative renal dysfunction (p < 0.01), and was also an independent predictor of increased length of stay (p < 0.01) and gastrointestinal disorders (p < 0.05). Thus, hypoalbuminemia is a powerful indicator of ah increased risk of perioperative complications in elderly patients undergoing cardiac surgery. Increased attention to nutritional factors is warranted in these patients.

Surgical Treatment of Aneurysms of the Descending Thoracic Aorta: An Analysis of 85 Patients

We have reviewed our experience with resection of 85 aneurysms of the descending thoracic aorta during a ten-and-one-half year interval ending in June, 1980. There were 39 arteriosclerotic aneurysms, 35 aneurysms associated with chronic aortic dissection, and 11 posttraumatic aneurysms. During repair, a temporary shunt was used in 56 patients (66%), partial (venoarterial) cardiopulmonary bypass (CPB) in 19 patients (22%), and simple aortic cross-clamping in 10 patients (12%). Hospital mortality was 11.8%, and was unrelated to the type of aneurysm or operative method. Spinal cord injury developed in 3 of the 83 patients surviving operation (3.6%), and occurred once with each of the three operative methods. Among the 82 operative survivors without preoperative renal failure, postoperative renal failure requiring hemodialysis occurred in 2 of the 10 patients who had simple aortic cross-clamping (20%), 2 of the 54 who had a shunt (3.7%), and in none of the 18 who underwent partial CPB ( p = 0.049). Postoperative renal dysfunction (a rise in the preoperative blood urea nitrogen and creatinine levels of 50% or more) occurred in 27 of the 53 patients (51%) who had preoperative and postoperative determinations. Age, intraoperative hypotension, and the use of simple aortic cross-clamping were significant ( p < 0.05) independent predictors of postoperative renal dysfunction. Intraoperative blood loss and the incidence of reoperation for bleeding did not differ significantly among the three operative methods. We conclude that the aneurysm resection technique and the development of intraoperative hypotension have an important effect on postoperative renal function. Partial CPB may represent the optimal method for preservation of renal function, and may also be the method of choice for elderly patients with preexisting renal dysfunction.