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Journal of Nephrology

, Volume 31, Issue 4, pp 561–569 | Cite as

Stroke volume variation and serum creatinine changes during abdominal aortic aneurysm surgery: a time-integrated analysis

  • Paolo Lentini
  • Luca Zanoli
  • Pasquale Fatuzzo
  • Faeq Husain-Syed
  • Rudi Stramanà
  • Diego Cognolato
  • Vincenzo Catena
  • Marco Baiocchi
  • Antonio Granata
  • Roberto Dell’Aquila
Original Article

Abstract

Background

Patients undergoing abdominal aortic aneurysm (AAA) surgery with suprarenal clamping are at high risk for acute kidney injury (AKI) and major cardiac and cerebrovascular events (MACCE). We aimed to assess whether the stroke volume variation (SVV), a measure of hemodynamic instability, is associated with AKI in hypertensive patients undergoing elective AAA surgery with suprarenal clamping.

Methods

In a cohort of 51 hypertensive patients, we performed serial measurements of SVV (n = 459) and serum creatinine (sCr) (n = 255). AKI was defined according to the KDIGO clinical practice guidelines. Data were analyzed by repeated-measures ANOVA and regression analysis of time-integrated changes of both SVV and sCr.

Results

AKI developed in 45% of patients (stage 1: 31%; stage 2: 10%; stage 3: 2%). The diuresis during surgery (beta − 0.29 Z-score 95% [CI − 0.54, − 0.05]; p = 0.02), clamp time (beta 0.29 Z-score [0.05–0.52]; p = 0.02), and time-integrated changes in SVV from baseline to 12 h after surgery (beta 0.31 Z-score [0.03–0.60]; p = 0.03) were independent predictors of the time-integrated changes in sCr from baseline to 48 h after the end of surgery. In a model adjusted for age and sex, patients with AKI had an increased risk for MACCE during a mean follow-up of 3.5 ± 1.1 years (HR 5.53 [1.52–20.06]; p = 0.004).

Conclusions

SVV increases progressively during and after AAA surgery in subjects who will develop AKI. The increase of SVV precedes and predicts the rise in sCr and is a good discriminator of the development of AKI. AKI is associated with an increased long-term risk for MACCE.

Keywords

Abdominal aortic aneurysm Acute kidney injury Anesthesia Hemodynamics Hypertension 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Italian Society of Nephrology 2018

Authors and Affiliations

  • Paolo Lentini
    • 1
  • Luca Zanoli
    • 2
  • Pasquale Fatuzzo
    • 2
  • Faeq Husain-Syed
    • 3
  • Rudi Stramanà
    • 4
  • Diego Cognolato
    • 4
  • Vincenzo Catena
    • 5
  • Marco Baiocchi
    • 5
  • Antonio Granata
    • 6
  • Roberto Dell’Aquila
    • 1
  1. 1.Nephrology and Dialysis“St. Bassiano” HospitalBassano del GrappaItaly
  2. 2.Internal Medicine, School of NephrologyUniversity of CataniaCataniaItaly
  3. 3.Pneumology and Intensive Care MedicineUniversity Hospital Giessen and MarburgGiessenGermany
  4. 4.Vascular Surgery“St. Bassiano” HospitalBassano del GrappaItaly
  5. 5.Intensive Care Medicine“St. Bassiano” HospitalBassano del GrappaItaly
  6. 6.Nephrology and Dialysis“St. Giovanni di Dio” HospitalAgrigentoItaly

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