title: Renal Function is the Main Predictor of Acute Kidney Injury after Endovascular Abdominal Aortic Aneurysm Repair.
abstract: BACKGROUND
  Postoperative acute kidney injury (AKI) may occur in up to 18% of elective endovascular abdominal aortic aneurysm repair (EVAR) and has been associated with poor outcome; however, it is not clear which patients are at highest risk, to target renoprotection effectively. We sought to determine the predictive factors of AKI after elective EVAR.
  
  
  METHODS
  Overall, 947 patients undergoing elective EVAR between January 2004 and December 2014 were analyzed, using prospectively collected data. Postoperative AKI was defined by serum creatinine change within 48 hr, as per the Kidney Disease Improving Global Outcomes guidelines. Cardiovascular and kidney-disease risk factors were entered in univariate and multivariate analyses to assess influence on AKI development.
  
  
  RESULTS
  Overall, 167 (17.6%) patients developed AKI but only 2 patients required dialysis perioperatively. At multivariate analysis, adjusted for established AKI-risk factors and parameters that differed between groups at baseline, preoperative estimated glomerular filtration rate (eGFR; as per the chronic kidney disease epidemiology [CKD] formula); odds ratio (OR): 1.02 (per unit decrease); 95% confidence interval (CI): 1.003-1.041; P = 0.025; and chronic kidney disease (CKD) stage > 2 (OR: 1.28; 95% CI: 1.249-2.531, P = 0.001) were associated with development of AKI.
  
  
  CONCLUSIONS
  AKI was common after elective infrarenal EVAR and preoperative renal function appears to be the main factor associated with AKI. Patients with a low eGFR need to be targeted with more aggressive renal protection.
authors.affiliation: Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK. Electronic address: as875@le.ac.uk.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Saratzis
authors.affiliation: Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nduwayo
authors.affiliation: Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Sarafidis
authors.affiliation: Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sayers
authors.affiliation: Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bown
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine