Acute renal injury and dysfunction following elective abdominal aortic surgery.
OBJECTIVE
To evaluate the incidence of kidney injury and acute renal dysfunction (ARD) and associated risk factors in open abdominal aortic surgery.


METHODS
69 patients undergoing elective infrarenal aortic repair were included in a prospective study. Anaesthesia and haemodynamic management were standardised targeting a mean arterial pressure (MAP) of 70-90 mmHg, pulmonary artery occlusion pressure of 12-14 mmHg and cardiac index >or=2.4 l/min/m(2). Urinary albumin-creatinine and N-acetyl-B-D-glucosaminidase-creatinine ratios were measured as indicators of kidney injury. The definition of ARD was based on the RIFLE criteria.


RESULTS
Kidney injury was found in most patients. ARD developed in 22% of the patients, and acute renal failure in 4%. The patients with ARD were older, and had lower plasma creatinine and estimated GFR before surgery. ARD was associated with intraoperative hypotension (MAP <60 mmHg >15 min), low cardiac index (<2.4 l/min/m(2)), rhabdomyolysis, and early reoperation. Intraoperative hypotension and postoperative low cardiac output were independent risk factors for ARD in multivariate analysis.


CONCLUSIONS
Kidney injury occurs in most patients undergoing infrarenal aortic surgery, but only 22% develop acute renal dysfunction. Hypotension and low cardiac output are risk factors that could be avoided by optimizing perioperative management.
Tallgren
M
M
Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland. minna.tallgren@hus.fi
Niemi
T
T
Pöyhiä
R
R
Raininko
E
E
Railo
M
M
Salmenperä
M
M
Lepäntalo
M
M
Hynninen
M
M
D000118:Acetylglucosaminidase / Q000097:blood; D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D002303:Cardiac Output, Low; D003404:Creatinine / Q000097:blood; D017558:Elective Surgical Procedures; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D003404:Creatinine; D000118:Acetylglucosaminidase