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Prevalent cardiac, renal and cardiorenal damage in patients with advanced abdominal aortic aneurysms

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Abstract

Chronic kidney disease (CKD), cardiac damage (CD) and the combination of the two are associated with increased morbidity and death in patients admitted to vascular surgery units. We assessed the prevalence of cardiac and renal damage and cardiorenal syndrome (CRS) in 563 patients with abdominal aortic aneurysms (AAA) who underwent cardiac screening before either an endovascular procedure (EVAR) or open surgery (OS) for aneurysm repair. CD was defined by ≥stage B as per the ACC/AHA classification of congestive heart failure (CHF), while CKD was defined by estimated GFR <60 mL/min/1.73 m2 (CKD-EPI). Anemia [World Health Organization (WHO) guidelines] and iron deficiency (ID) (criteria for CHF patients) were also calculated. AAA patients were stratified into the following groups: CD, CKD, CRS or none of these conditions [no risk factors (NoRF)]. The prevalence of isolated cardiac and renal structural damage, of combined cardiorenal damage and of ID was 24.1, 15.0, 20.6 and 23.4 %, respectively. The frequency of anemia (mostly unrecognized) among the groups increased from NoRF (12.8 %)/CKD (19 %)/CD (25 %) up to CRS (38.8 %). This large-scale observational study provides clues for the increased CD/CKD risk profiles of unselected AAA patients, and underlines the need for better identification of ID/anemia and for appropriate treatment of CKD and CD before these patients undergo EVAR/OS.

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Acknowledgments

The authors thank Valerie Frances Perricone for editorial assistance, Paola Rebizzo, RN of the Department of Internal Medicine, Cardiology, and Rosalba Ricchebuono, RN of the Unit of Vascular and Endovascular Surgery, at the IRCCS University Hospital San Martino, Genova for collecting the blood samples.

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    Authors and Affiliations

    1. Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy

      Chiara Barisione, Silvano Garibaldi, Claudio Brunelli, Manrico Balbi, Paolo Spallarossa, Marco Canepa, Pietro Ameri, Alessandra Lorenzoni, Riccardo Baldassini, Domenico Palombo, Bianca Pane, Giovanni Spinella & Giorgio Ghigliotti

    2. Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy

      Francesca Viazzi & Daniela Verzola

    3. Unit of Vascular and Endovascular Surgery, University of Genova, Genova, Italy

      Giorgio Ghigliotti

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    1. Chiara Barisione
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    Correspondence to Giorgio Ghigliotti.

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    The study protocol was approved by the local Ethics Committee and conforms to the ethical guidelines of the 1974 Declaration of Helsinki.

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    C. Barisione and S. Garibaldi contributed equally to the study.

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    Barisione, C., Garibaldi, S., Brunelli, C. et al. Prevalent cardiac, renal and cardiorenal damage in patients with advanced abdominal aortic aneurysms. Intern Emerg Med 11, 205–212 (2016). https://doi.org/10.1007/s11739-015-1328-z

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