title: Progression to stage 3 and 4 chronic kidney disease and risk factor stratification following endovascular aortic aneurysm repair.
abstract: BACKGROUND
  Risk of progression to various stages of chronic kidney disease (CKD) after endovascular aortic aneurysm repair (EVAR) is unknown. This study estimates progression rates to stage 3 and 4 CKD after EVAR and identifies potential predictors for progression.
  
  
  METHODS
  EVAR cases (2006-2012) were retrospectively reviewed. Freedom of progression to CKD was estimated using Kaplan-Meier analysis, and predictors for progression were identified using Cox proportional hazards model.
  
  
  RESULTS
  Two hundred and twelve consecutive patients at a single academic institution underwent EVAR for infrarenal aneurysms. Estimated freedom from progression to stage 3 CKD was 80%, 76%, and 63% at 6, 12, and 18 months, respectively, and for stage 4, 97%, 96%, and 93% at 6, 12, and 18 months, respectively. Stage 3 CKD predictors of progression included age (odds ratio (OR): 1.106, p = 0.001), diabetes (OR: 3.052, p = 0.04), perioperative use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers (OR: 3.249, p = 0.02), and operative blood loss (OR: 1.002, p < 0.01). Stage 4 predictors included preoperative hemoglobin (OR: 0.473, p = 0.04) and baseline renal function (OR: 0.928, p = 0.001). Intraoperative contrast administration did not impact CKD development.
  
  
  CONCLUSIONS
  Progression to stage 3 CKD after EVAR occurs more frequently and at a higher rate compared with progression to stage 4. Different risk factors are associated with progression to each of those stages of CKD.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA muhammed@bcm.edu.|Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Somala
authors.initials: S
authors.lastname: Mohammed
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.|Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.|Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kougias
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.|Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Taher M
authors.initials: TM
authors.lastname: Mandviwala
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.|Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.|Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.|Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.|Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: George T
authors.initials: GT
authors.lastname: Pisimisis
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D018450:Disease Progression; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chronic kidney disease; endovascular aortic aneurysm repair; stage 3 CKD; stage 4 CKD