title: Preoperative Evaluation of the Renal Function before the Treatment of Abdominal Aortic Aneurysms.
abstract: BACKGROUND
  Chronic impaired renal function constitutes a major risk factor of morbi-mortality during the treatment of an abdominal aortic aneurism (AAA). The inflammatory state due to the AAA could result in a reduction in the muscular mass and an overestimation of the glomerular filtration rate (GFR) with the usual formulas. The objective of this study was to determine if the formulas used to evaluate the estimated GFR were adapted in patients with AAA.
  
  
  METHODS
  Between August 2013 and November 2014, we conducted an exploratory study to evaluate the renal function before surgery for AAA in 28 patients. The renal function was evaluated by (1) the dosage of plasmatic creatinine, (2) the GFR estimated with the Cockroft-Gault, Modification of Diet in Renal Disease (MDRD), and chronic kidney disease epidemiology collaboration (CKD-EPI) formulas, (3) the creatinine clearance (CC), and (4) the direct measurement of the GFR with a reference method (iohexol clearance). Statistical analysis was carried out to compare and correlate the GFR estimated by the various formulas with the GFR measured by the reference technique.
  
  
  RESULTS
  The study included 21 men (75%) and 7 women (25%), with a median age of 76 years (58-89). The measured GFR was correlated with the GFR estimated from the CKD-EPI (rho = 0.78, P < 0.0001), the MDRD (rho = 0.78, P < 0.0001), the Cockroft-Gault (rho = 0.65, P = 0.0002), and CC (rho = 0.86, P < 0.0001). However, there were important individual variations between estimated and measured GFR. As regards the detection of the patients presenting a GFR <60 mL/min/1.73 m2, the sensitivities of the CKD-EPI, MDRD, Cockroft-Gault formulas and CC were 64%, 64%, 71%, and 70%, respectively. Specificities were 71%, 79%, 57%, and 100%, respectively. The estimation of the GFR by the CKD-EPI formula had the lowest bias (-3.0). Bland-Altman plots indicated that the estimation of the GFR by the CKD-EPI formula had the best performance in comparison with the other methods.
  
  
  CONCLUSIONS
  This study found a statistical correlation between the measurement of the GFR and the various formulas available to estimation the GFR among AAA patients. The CKD-EPI formula is most appropriate. However, there were important individual variations between the measurement and the estimations of the GFR. A larger scale study is necessary to determine the profile of the patients with a risk of error in the estimation of the GFR. The French recommendations on the evaluation of the renal function before AAA treatment remain based on serum creatinine and should be revalued.
authors.affiliation: Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France; INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France. Electronic address: rcoscas@gmail.com.
authors.forename: Raphael
authors.initials: R
authors.lastname: Coscas
authors.affiliation: INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France; Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT) Network, Vandoeuvre-lès-Nancy, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Wagner
authors.affiliation: INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France; Service de Néphrologie-Dialyse, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France.
authors.forename: Eve
authors.initials: E
authors.lastname: Vilaine
authors.affiliation: INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France.
authors.forename: Albane
authors.initials: A
authors.lastname: Sartorius
authors.affiliation: Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Javerliat
authors.affiliation: Department of Pharmacology and Toxicology, Raymond Poincare Hospital, AP-HP, and INSERM U-1173, Université de Versailles Saint-Quentin en Yvelines, Garches, France.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Alvarez
authors.affiliation: Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France; INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Goeau-Brissonniere
authors.affiliation: Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Coggia
authors.affiliation: INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France; Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT) Network, Vandoeuvre-lès-Nancy, France; Service de Néphrologie-Dialyse, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Massy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000008:administration & dosage; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015233:Models, Statistical; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D015203:Reproducibility of Results; D000068436:Surgical Clearance
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D007472:Iohexol; D003404:Creatinine