How Is Renal Function Affected by Endoprosthesis Implantation?

The occurrence of renal failure after any endovascular intervention is associated with increased morbility and mortality. After a coronary intervention (whether it be angioplasty or surgery), renal failure increases mortality 20-fold.

Relatedly, surgical repair of an abdominal aortic aneurysm with renal failure is also associated with a significant increase in the number of events.

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After endovascular repair with an endoprosthesis, the reported range of renal failure is very wide (3% to 19%). This is probably due to the variety of definitions used in different studies. Upon analysis of the last published papers using the standardized definitions provided by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines, the reported rate of renal failure is about 20%.

This study included a cohort of 212 consecutive patients who underwent elective endovascular repair for abdominal aortic aneurysm from 2009 to 2016.

A subgroup of 149 patients with a 2-year follow-up after the procedure was compared with a group of 135 patients with similar risk profiles but smaller aneurysms that had not required treatment yet.

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The primary endpoint was acute kidney injury and the progression of renal failure over time.

Acute kidney injury occurred in 30 patients (15%); the use of angiotensin II blockers (odds ratio [OR]: 4.08) and peri-operative complications (OR: 3.12) were its independent predictors. On the contrary, statin use was a protective factor (OR: 0.19).

Prior endoprosthesis implantation resulted in a 23.5% increase in the occurrence of chronic kidney impairment compared with the control group.

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On multivariate analysis, larger aortic neck diameter, renal artery stenosis, and the occurrence of acute kidney injury were predictors of progressive kidney function impairment over time.

Conclusion

This study identified the use of angiotensin II blockers and peri-operative complications as the most significant predictors for acute kidney injury. Additionally, the fact that renal function tends to decline progressively after endoprosthesis implantation seems to be clear, which indicates the need to prolong protective measures over time, particularly in higher risk patients.

Original title: Determinants of Acute Kidney Injury and Renal Function Decline After Endovascular Abdominal Aortic Aneurysm Repair.

Reference: Statius van Eps RG et al. Eur J Vasc Endovasc Surg. 2017 Oct 27. Epub ahead of print.

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