title: Evaluation of acute kidney injury as defined by the risk, injury, failure, loss, and end-stage criteria in critically ill patients undergoing abdominal aortic aneurysm repair.
abstract: BACKGROUND
  Acute kidney injury (AKI) is considered as a common and significant complication following abdominal aortic aneurysm (AAA) repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population.
  
  
  METHODS
  We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage (RIFLE) kidney disease criteria. The goal-directed hemodynamic optimization (maintenance of optimal hemodynamics and neutral or negative fluid balance) and renal outcomes were also reviewed.
  
  
  RESULTS
  Of the 71 patients enrolled, 32 (45.1%) developed AKI, with 30 (93.8%) cases diagnosed on admission to surgical intensive care unit (SICU). Risk factors for AKI were ruptured AAA (odds ratio (OR) = 5.846, 95% confidence interval (CI): 1.346 - 25.390), intraoperative hypotension (OR = 6.008, 95%CI: 1.176 to 30.683), and perioperative blood transfusion (OR = 4.611, 95%CI: 1.307 - 16.276). Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay ((136.9 ± 24.5) hours vs. (70.4 ± 11.3) hours) in Surgical Intensive Care Unit.
  
  
  CONCLUSIONS
  Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.
authors: Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors: Jia-ning
authors: JN
authors: Yue
authors: Zhe
authors: Z
authors: Luo
authors: Da-qiao
authors: DQ
authors: Guo
authors: Xin
authors: X
authors: Xu
authors: Bin
authors: B
authors: Chen
authors: Jun-hao
authors: JH
authors: Jiang
authors: Jue
authors: J
authors: Yang
authors: Zhen-yu
authors: ZY
authors: Shi
authors: Ting
authors: T
authors: Zhu
authors: Min-jie
authors: MJ
authors: Ju
authors: Guo-wei
authors: GW
authors: Tu
authors: Yu-qi
authors: YQ
authors: Wang
authors: Du-ming
authors: DM
authors: Zhu
authors: Wei-guo
authors: WG
authors: Fu
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D016638:Critical Illness; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors