title: Predictors of creatinine rise post-endovascular abdominal aortic aneurysm repair.
abstract: BACKGROUND
  Endovascular abdominal aortic aneurysm repair involves manipulation of the aorta around the renal arteries. Fenestrated grafts involve the direct cannulation, stenting and injecting of contrast into the renal arteries. These procedures may be associated with an acute post-operative creatinine rise.
  
  
  METHODS
  We retrospectively examined data from all endovascular aortic repairs at our institution from 2005 to 2009, where contrast dosage had been recorded. Renal impairment was defined as a 25% increase in creatinine during the 5-day postoperative period. Univariable analysis was undertaken for a number of likely predictors, including: age, contrast dosage, preoperative creatinine, graft type (fenestrated or standard), diabetes mellitus, hypertension, hypercholesterolaemia, ischaemic heart disease, aspirin therapy, statins therapy, non-steroidal anti-inflammatory drug use, preoperative N-acetyl-cysteine and intravenous pre-hydration. Multivariable analysis was then applied to variables with a univariable P-value of < 0.05.
  
  
  RESULTS
  We identified 106 consecutive cases, with complete data for 102. Twenty per cent of patients developed renal impairment (22/102). Contrast dose (P = 0.043) and fenestrated grafts (P = 0.006) were identified as significant risk factors for post-operative creatinine increase (P = 0.043). Multivariable analysis demonstrated that fenestrated grafts were a risk factor independent of contrast dosage (P < 0.05).
  
  
  CONCLUSIONS
  Patients who received a fenestration graft (P < 0.01) and increased contrast dose (P < 0.05) were at a significant increased risk of a 25% post-operative creatinine rise. The risk of fenestration grafts persisted when multivariable regression was performed to control for contrast dosage (P < 0.05). Other variables investigated were not found to be significant in this study.
authors.affiliation: Department of Vascular Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia. chrisebrooks@gmail.com
authors.forename: Christopher Earle
authors.initials: CE
authors.lastname: Brooks
authors.forename: Andrew
authors.initials: A
authors.lastname: Middleton
authors.forename: Rana
authors.initials: R
authors.lastname: Dhillon
authors.forename: David
authors.initials: D
authors.lastname: Scott
authors.forename: Michael
authors.initials: M
authors.lastname: Denton
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000378:metabolism; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003287:Contrast Media; D003404:Creatinine / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000378:metabolism*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine