Acute Kidney Injury in Patients Undergoing Open Abdominal Aortic Aneurysm Repair: A Pilot Observational Trial.
OBJECTIVE
Acute kidney injury (AKI) is a frequent complication after open repair of abdominal aortic aneurysms (AAA). Little research has been done to determine whether intraoperative hemodynamic events may precipitate AKI. Novel biomarkers also may aid in the earlier diagnosis of AKI.


METHODS
A pilot prospective observational trial.


METHODS
A single tertiary academic medical center.


METHODS
Participants were 40 adult patients undergoing open repair of infrarenal AAA.


METHODS
Intraoperative hemodynamic monitoring of heart rate, mean arterial pressure, central venous pressure, and cardiac index was performed on a continuous basis. Blood samples were obtained at baseline and at 24 hours postoperatively for inflammatory biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL).


RESULTS
AKI occurred in 20% of patients (8 of 40). Hypotension, including duration (defined as the length of time mean arterial pressure was<65 mmHg) and magnitude (the area under the curve of a mean arterial pressure<65 mmHg), was the only factor associated with postoperative AKI. Urinary NGAL at the conclusion of surgery had excellent ability to predict the development of AKI (area under the curve 0.84, 95% confidence interval = 0.70-0.97). The cytokines pentraxin 3 (PTX3), interleukin-1 receptor antagonist (IL1-RA), macrophage chemotactic protein (MCP), suppressor of tumorigenicity 2 (ST-2), and interleukin-10 (IL-10) also had good ability to predict the development of AKI in the immediate postoperative period.


CONCLUSIONS
AKI occurs frequently in patients undergoing open repair of AAA. Intraoperative hypotension was the only factor that predicted the development of subsequent AKI. Urinary NGAL and several novel inflammatory biomarkers demonstrated good ability to predict its development. Novel biomarkers also may aid in the early diagnosis of AKI.
Anesthesiology.
Ryan
R
Brinkman
Immunology.
Kent T
KT
HayGlass
Anesthesiology.
W A C
WA
Mutch
Anesthesiology; Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: funk@cc.umanitoba.ca.
Duane J
DJ
Funk
D058186:Acute Kidney Injury / Q000097:blood* / Q000453:epidemiology* / Q000503:physiopathology; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D010865:Pilot Projects; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies
D015415:Biomarkers
abdominal; acute kidney injury; aortic aneurysm; hypotension; intraoperative; monitoring