Risk factors and outcomes associated with acute kidney injury following ruptured abdominal aortic aneurysm
Open Access
- 1 May 2013
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Nephrology
- Vol. 14 (1), 99-9
- https://doi.org/10.1186/1471-2369-14-99
Abstract
Background Current data describing the epidemiology of acute kidney injury (AKI) following repair of ruptured abdominal aortic aneurysm (rAAA) are limited and long-term outcomes are largely unknown. Our objectives were to describe the incidence rate, risk factors, clinical course and long-term outcomes of AKI following rAAA repair. Methods Retrospective population-based cohort study of all referrals undergoing emergency repair of rAAA in Northern Alberta from January 1, 2002 to December 31 2009. Demographic, clinical, physiologic and laboratory data were extracted. AKI was defined and classified according to the AKIN criteria. Results In total, 140 patients survived to receive emergent rAAA repair. Post-operative AKI occurred in 75.7% of patients (n = 106), 78.3% (n = 83) of which occurred during the initial 24 hours of ICU admission. AKIN stage 1, 2, and 3 occurred in 47 (33.6%), 36 (25.7%) and 23 (16.4%), respectively, with 19 patients receiving renal replacement therapy (RRT). Several clinical and biochemical patient factors were associated with incident AKI, including baseline estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 (odds ratio [OR] 2.94; 95% CI, 1.15-7.51, p = 0.03), need for mechanical ventilation (OR 22.7; 95% CI, 7.0-72.1, p < 0.0001) and vasoactive therapy (OR 9.9; 95% CI, 3.0-32.2, p < 0.0001) and higher mean APACHE II scores (25.7 [8.2] vs. 16.3 [4.9], p < 0.0001). AKI was associated with a higher ICU (28.3% vs. 0%; p = 0.0008) and in-hospital case-fatality rate (35.9% vs. 0%, p = 0.0001). Of 102 survivors to discharge, 65.7% (n = 67) recovered to baseline kidney function. In multivariable analysis, greater severity of AKI (OR 5.01; 95% CI, 2.34-10.7, p < 0.001) and lower baseline eGFR (OR 0.96; 95% CI, 0.93-0.99, p = 0.03) were associated with non-recovery. AKI remained independently associated with 1-year mortality after adjusting for age, sex, comorbidity, and illness severity (OR 5.21; 95% CI, 1.04-26.2, p = 0.045; AUC 0.83; H-L GoF, p = 0.26). Among survivors at 1-year, only 63.4% (n = 55) had complete kidney recovery. Conclusions Following rAAA repair, AKI is a common complication independently associated with long-term post-operative mortality. A significant proportion of AKI sufferers in this setting fail to recover to baseline kidney function.Keywords
This publication has 33 references indexed in Scilit:
- Impact of intensive care unit admission during morning bedside rounds and mortality: a multi-center retrospective cohort studyCritical Care, 2012
- The severity of acute kidney injury predicts progression to chronic kidney diseaseKidney International, 2011
- The duration of postoperative acute kidney injury is an additional parameter predicting long-term survival in diabetic veteransKidney International, 2010
- Temporary Perioperative Decline of Renal Function Is an Independent Predictor for Chronic Kidney DiseaseClinical Journal of the American Society of Nephrology, 2010
- Endovascular treatment of ruptured abdominal aortic aneurysms in the United States (2001-2006): A significant survival benefit over open repair is independently associated with increased institutional volumeJournal of Vascular Surgery, 2009
- Impact of Mild Acute Kidney Injury (AKI) on Outcome after Open Repair of Aortic AneurysmsRenal Failure, 2008
- Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studiesBMJ, 2007
- Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injuryCritical Care, 2007
- Outcome of Acute Renal Failure Following Surgical Repair of Ruptured Abdominal Aortic AneurysmsEuropean Journal of Vascular and Endovascular Surgery, 2000
- APACHE IICritical Care Medicine, 1985