Document Detail

Impact of mild acute kidney injury (AKI) on outcome after open repair of aortic aneurysms.
MedLine Citation:
PMID:  18350448     Owner:  NLM     Status:  MEDLINE    
Recently, mild AKI has been considered as a risk factor for mortality in different scenarios. We conducted a retrospective analysis of the risk factors for two distinct definitions of AKI after elective repair of aortic aneurysms. Logistic regression was carried out to identify independent risk factors for AKI (defined as $25% or $50% increase in baseline SCr within 48 h after surgery, AKI 25% and AKI 50%, respectively) and for mortality. Of 77 patients studied (mean age 68 +/- 10, 83% male), 57% developed AKI 25% and 33.7% AKI 50%. There were no differences between AKI and control groups regarding comorbidities and diameter of aneurysms. However, AKI patients needed a supra-renal aortic cross-clamping more frequently and were more severely ill. Overall in-hospital mortality was 27.3%, which was markedly higher in those requiring a supra-renal aortic cross-clamping. The risk factors for AKI 25% were supra-renal aortic cross-clamping (odds ratio 5.51, 95% CI 1.05-36.12, p = 0.04) and duration of operation for AKI 25% (OR 6.67, 95% CI 2.23-19.9, p < 0.001). For AKI 50%, in addition to those factors, post-operative use of vasoactive drugs remained as an independent factor (OR 6.13, 95% CI 1.64-22.8, p = 0.005). The risk factors associated with mortality were need of supra-renal aortic cross-clamping (OR 9.6, 95% CI 1.37-67.88, p = 0.02), development of AKI 50% (OR 8.84, 95% CI 1.31-59.39, p = 0.02), baseline GFR lower than 49 mL/min (OR 17.07, 95% CI 2.00-145.23, p = 0.009), and serum glucose > 118 mg/dL in the post-operative period (OR 19.99, 95% CI 2.32-172.28, p = 0.006). An increase of at least 50% in baseline SCr is a common event after surgical repair of aortic aneurysms, particularly when a supra-renal aortic cross-clamping is needed. Along with baseline moderate chronic renal failure, AKI is an independent factor contributing to the high mortality found in this scenario.
Etienne Macedo; Isac Castro; Luis Yu; Regina R C Abdulkader; José M Vieira
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Renal failure     Volume:  30     ISSN:  1525-6049     ISO Abbreviation:  Ren Fail     Publication Date:  2008  
Date Detail:
Created Date:  2008-03-19     Completed Date:  2008-06-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701128     Medline TA:  Ren Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  287-96     Citation Subset:  IM    
Renal Division, Internal Medicine, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
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MeSH Terms
Aortic Aneurysm / surgery*
Brazil / epidemiology
Cardiovascular Surgical Procedures / adverse effects*
Kidney Failure, Acute / etiology*,  mortality
Middle Aged
Retrospective Studies
Risk Factors
Severity of Illness Index

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