title: Incidence and risk factors of renal dysfunction after thoracic endovascular aortic repair.
abstract: OBJECTIVE
  The risk of renal failure after thoracic endovascular aortic repair is not widely established. The aim of this study was to assess the incidence and risk factors of renal failure.
  
  
  METHODS
  Between 1998 and 2008, 175 consecutive patients underwent 210 procedures at 2 tertiary academic institutions. Similar nephroprotective protocols and intravascular ultrasound were used. Retrospective analysis was performed. Generalized linear model was used to identify factors associated with change in postoperative estimated glomerular filtration rate.
  
  
  RESULTS
  Underlying aortic diseases included 103 aneurysms, 72 dissections, 21 transections, and 14 penetrating ulcers. Median preoperative estimated glomerular filtration rate was 65 mL · min(-1) · 1.73 m(-2). Contrast media averaged 108.7 ± 69.8 mL. Median estimated glomerular filtration rates within 48 hours and 30 days were 69 and 67 mL · min(-1) · 1.73 m(-2), respectively. Rates of acute renal dysfunction risk (>25% estimated glomerular filtration rate decrease), acute kidney injury (>50% estimated glomerular filtration rate decrease), acute kidney function failure (>75% estimated glomerular filtration rate decrease), and hemodialysis were 9.8% (19/193), 1.6% (3/193), 0% (0/193), and 0.5% (1/193), respectively. Rates of renal dysfunction at 1 month and 6 months were 13.3% (10/75) and 17.7% (6/34), respectively. Risk factors for acute renal dysfunction were intraoperative hypotension, stroke, sepsis, lengthy procedures, and number of stents; at 1 and 6 months they were increased age, male gender, African American race, diabetes mellitus, chronic pulmonary disease, smoking, and zone 0 to 1 graft deployment. Obesity was nephroprotective.
  
  
  CONCLUSIONS
  Thoracic aortic endograft has a significant rate of renal dysfunction; however, it is lower in this cohort than in previous smaller series. Routine use of intravascular ultrasound and reduced contrast may have contributed to lower rates of renal insufficiency.
authors.affiliation: Cedars-Sinai Medical Center, Division of Cardiothoracic Surgery, Los Angeles, CA, USA.
authors.forename: George T
authors.initials: GT
authors.lastname: Pisimisis
authors.forename: Ali
authors.initials: A
authors.lastname: Khoynezhad
authors.forename: Khalid
authors.initials: K
authors.lastname: Bashir
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kruse
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Donayre
authors.forename: Rodney A
authors.initials: RA
authors.lastname: White
mesh_terms: D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002140:California; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009329:Nebraska; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013812:Therapeutics