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Acute kidney injury after abdominal aortic aneurysm repair: current epidemiology and potential prevention

  • Nephrology - Original Paper
  • Published:
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Abstract

Purpose

Acute kidney injury (AKI) is a severe complication after infrarenal abdominal aortic aneurysm (iAAA) repair. Little data are available whether endovascular aneurysm (EVAR) or open aortic repair (OAR) differs with respect to AKI frequency and severity, consecutive development of chronic kidney disease (CKD) and potentially preventable and modifiable risk factors of AKI.

Patients and methods

We assessed AKI rates, AKI stages and CKD applying current, complete definitions from the kidney disease improving global outcomes initiative in propensity-score-matched cohorts of all patients with elective and urgent iAAA repair at our institution from 2007 to 2011. Risk factors were analysed using multivariate logistic regression analyses.

Results

From 268 patients, we identified 91 matched pairs who had undergone either EVAR or OAR. The AKI rate was 13.2% with EVAR versus 41.8% with OAR (P < 0.001). AKI was significantly less severe in EVAR. OAR patients lost more glomerular filtration rate (− 11.3 vs. − 6.5%; P = 0.02) and developed more frequently CKD (14.3 vs. 3.2%; P < 0.001) 3 months after iAAA repair. EVAR, circulatory shock, radiocontrast media, rhabdomyolysis and sepsis were identified as potentially preventable or modifiable risk factors of AKI.

Conclusions

AKI is significantly less frequent and severe in iAAA patients after EVAR as compared to OAR. Furthermore OAR patients demonstrate a higher CKD rate. The identified risk factors may be prevented or modified as a bundle of measures especially in patients with pre-existing CKD to reduce AKI and its severity after iAAA repair.

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Acknowledgements

We kindly thank Mrs. Ann-Kathrin Lenz for her expert revision of our manuscript and Dr. Walter Schill, Leibniz Institute for Prevention Research and Epidemiology, Bremen, for his expert statistical advice.

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Authors and Affiliations

  1. Department of Medicine, Rotes Kreuz Krankenhaus, St.-Pauli-Deich 24, 28199, Bremen, Germany

    Liesa Zabrocki & Stefan Herget-Rosenthal

  2. Department of Vascular Medicine, Rotes Kreuz Krankenhaus, Bremen, Germany

    Frank Marquardt

  3. Controlling, Rotes Kreuz Krankenhaus, Bremen, Germany

    Klaus Albrecht

  4. Department of Nephrology, University Duisburg-Essen, Essen, Germany

    Stefan Herget-Rosenthal

Authors
  1. Liesa Zabrocki
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  2. Frank Marquardt
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  3. Klaus Albrecht
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  4. Stefan Herget-Rosenthal
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Corresponding author

Correspondence to Stefan Herget-Rosenthal.

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Conflict of interest

Author FM has received speaker honorarium from company Trivascular, Inc. and the Department of Vascular Medicine an educational grant from company Gore, Inc. All other authors declare that they have no conflicts 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. The study protocol was approved by the local ethics committee. The requirement of obtaining informed consent from participants was waived by the local ethics committee.

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Zabrocki, L., Marquardt, F., Albrecht, K. et al. Acute kidney injury after abdominal aortic aneurysm repair: current epidemiology and potential prevention. Int Urol Nephrol 50, 331–337 (2018). https://doi.org/10.1007/s11255-017-1767-8

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  • DOI: https://doi.org/10.1007/s11255-017-1767-8

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