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. 2015 May;12(3):232-8.
doi: 10.11909/j.issn.1671-5411.2015.03.002.

Relationship between acute kidney injury before thoracic endovascular aneurysm repair and in-hospital outcomes in patients with type B acute aortic dissection

Hong-Mei Ren  1 , Xiao Wang  1 , Chun-Yan Hu  2 , Bin Que  1 , Hui Ai  1 , Chun-Mei Wang  1 , Li-Zhong Sun  3 , Shao-Ping Nie  1
Affiliations

Relationship between acute kidney injury before thoracic endovascular aneurysm repair and in-hospital outcomes in patients with type B acute aortic dissection

Hong-Mei Ren et al. J Geriatr Cardiol. 2015 May.

Abstract

Objective: Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. However, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain unclear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD.

Methods: Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease: improving global outcomes criteria before TEVAR.

Results: The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0% vs. 4.2%, respectively; P < 0.001), including acute renal failure (21.4% vs. 0, respectively; P < 0.001), and they increased with severity of AKI (P < 0.001). The maximum levels of body temperature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR: 1.023; 95% CI: 1.003-1.044; P = 0.0238) and bilateral renal artery involvement (OR: 19.076; 95% CI: 1.914-190.164; P = 0.0120) were strong predictors of preoperative AKI.

Conclusions: Preoperative AKI frequently occurred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.

Keywords: Acute aortic dissection; Kidney injury; Renal failure; Thoracic endovascular aneurysm repair.

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Figures

Figure 1.
Figure 1.. The incidence of in-hospital complications in patients without AKI, developing AKI stage 1, AKI stage 2&3.
See this image and copyright information in PMC

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