title: A systematic review and meta-analysis indicates underreporting of renal dysfunction following endovascular aneurysm repair.
abstract: Deterioration in renal function has been described after endovascular repair of abdominal aortic aneurysms (EVRs). The etiology is multifactorial and represents an important therapeutic target. A need exists to quantitatively summarize incidence and severity of renal dysfunction after EVR to allow better-informed attempts to preserve renal function and improve life expectancy. Here a systematic search was performed using Medline and Embase for renal function after EVR applying PRISMA statements. Univariate and multivariate random-effects meta-analyses were performed to estimate pooled postoperative changes in serum creatinine and creatinine clearance at four time points after EVR. Clinically relevant deterioration in renal function was also estimated at 1 year or more after EVR. Pooled probability of clinically relevant deterioration in renal function at 1 year or more was 18% (95% confidence interval of 14-23%, I2 of 82.5%). Serum creatinine increased after EVR by 0.05 mg/dl at 30 days/1 month, 0.09 mg/dl at 1 month to 1 year, and 0.11 mg/dl at 1 year or more (all significant). Creatinine clearance decreased after EVR by 5.65 ml/min at 1 month-1 year and by 6.58 ml/min at 1 year or more (both significant). Thus, renal dysfunction after EVR is common and merits attention.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
authors.forename: Sandeep S
authors.initials: SS
authors.lastname: Bahia
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
authors.forename: Shaneel R
authors.initials: SR
authors.lastname: Patel
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
authors.forename: Bilal
authors.initials: B
authors.lastname: Azhar
authors.affiliation: MRC Biostatistics Unit, MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge.
authors.forename: Dan
authors.initials: D
authors.lastname: Jackson
authors.affiliation: MRC Biostatistics Unit, MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge.
authors.forename: Lynne
authors.initials: L
authors.lastname: Cresswell
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
authors.forename: Peter J E
authors.initials: PJ
authors.lastname: Holt
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, UK.
authors.forename: Matt M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D051437:Renal Insufficiency / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors
chemical_list: D003404:Creatinine