title: Risk factors for early renal dysfunction following endovascular aortic aneurysm repair and its effect on the postoperative outcome.
abstract: OBJECTIVE
  Renal insufficiency is associated with increased morbidity and death after endovascular aortic aneurysm repair (EVAR). However, the effect of postoperative acute kidney dysfunction on patient outcome has not been fully determined. This study aimed to determine the risk factors of early postoperative renal function decline using chronic kidney disease (CKD) staging and its effect on the clinical outcome.
  
  
  METHODS
  A retrospective analysis was performed on a prospectively maintained EVAR database. Pre- and postoperative CKD stages were determined for all patients according to the estimated glomerular filtration rate values.
  
  
  RESULTS
  We identified 135 patients who were treated with elective EVAR. CKD stage decline was observed in 25 (19 %) of the patients. Freedom from aneurysm-related death was significantly lower in patients with postoperative CKD progression compared with those with unchanged CKD stage. A shaggy aorta without oral beta-blocker administration and higher preoperative serum creatinine levels (>1.4 mg/dL) were found to be independent predictors of an early postoperative CKD stage decline.
  
  
  CONCLUSIONS
  Patients with postoperative CKD progression have an increased frequency of aneurysm-related death. The presence of a shaggy aorta, absence of oral beta-blocker administration and an increased preoperative creatinine level are independent predictors of early postoperative CKD progression.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, 163-1, Kashiwashita, Kashiwa, Chiba, 277-8567, Japan. toyanaoki@gmail.com.
authors.forename: Naoki
authors.initials: N
authors.lastname: Toya
authors.affiliation: Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Ohki
authors.affiliation: Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yasutake
authors.initials: Y
authors.lastname: Momokawa
authors.affiliation: Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, 163-1, Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Shukuzawa
authors.affiliation: Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, 163-1, Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Fukushima
authors.affiliation: Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Tachihara
authors.affiliation: Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Akiba
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology*; D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001014:Aortic Aneurysm / Q000150:complications / Q000473:pathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D003404:Creatinine
keywords: Abdominal aortic aneurysm; Chronic kidney disease; Complication; Endovascular aneurysm repair; Renal dysfunction