title: Impaired renal function is associated with mortality and morbidity after endovascular abdominal aortic aneurysm repair.
abstract: BACKGROUND
  Renal function may be associated with poor outcome following endovascular abdominal aortic aneurysm repair (EVAR), but this relationship has not been adequately investigated. The aim of this study is to evaluate the association of estimated glomerular filtration rate (eGFR) with cardiovascular events and all-cause mortality after EVAR.
  
  
  METHODS
  Prospective cohort study of patients undergoing elective EVAR; eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula, and patients were divided in four groups (eGFR ≥ 90 mL/min/1.73 m(2), group 1; 60-89, group 2; 30-59, group 3; <30, group 4). Composite end point consisted of death, nonfatal myocardial infarction, stroke, and vascular complications. Kaplan-Meier curves were constructed, and between-group comparisons were performed adjusted for variables that differed at baseline.
  
  
  RESULTS
  A total of 383 patients (mean age, 69 ± 8 years; mean abdominal aortic aneurysm diameter, 6.2 ± 1.4 cm) were included. Over a mean follow-up of 34 ± 12 months, the following events occurred: 20 deaths (5.2%), 15 nonfatal myocardial infarctions (3.9%), 9 nonfatal strokes (2.3%), and 7 peripheral vascular complications (1.8%). Patients with an eGFR <30 had the highest mortality (35%) and incidence of complications (80%) as per the end point (P = .009 and P < .001, respectively). Adjusted Cox-regression analysis showed that a higher eGFR at baseline by 1 mL/min/1.73 m(2) was associated with a 5% lower likelihood of complications as per the end point (P < .001; hazard ratio, 0.95; 95% confidence interval, 0.94-0.97) and a 6% lower likelihood of death (P < .001; hazard ratio, 0.94; 95% confidence interval, 0.92-0.97).
  
  
  CONCLUSIONS
  Impaired renal function is associated with an increase in cardiovascular events and mortality following elective EVAR.
authors.affiliation: Department of Vascular Surgery, Aristotle University, Thessaloniki, Greece; Department of Research and Development, Dudley Group of Hospitals NHS Trust, Dudley, United Kingdom. Electronic address: a_saratzis@yahoo.gr.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Saratzis
authors.forename: Pantelis
authors.initials: P
authors.lastname: Sarafidis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Melas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Saratzis
authors.forename: George
authors.initials: G
authors.lastname: Kitas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome