Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial

• Published in: British journal of surgery Vol. 100; no. 11; pp. 1465 - 1470
• Main Authors: de Bruin, J. L., Vervloet, M. G., Buimer, M. G., Baas, A. F., Prinssen, M., Blankensteijn, J. D.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-10-2013
• Subjects: Aged; Aortic Aneurysm, Abdominal - physiopathology; Aortic Aneurysm, Abdominal - surgery; Endovascular Procedures; Female; Follow-Up Studies; Glomerular Filtration Rate - physiology; Humans; Male; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Prospective Studies; Renal Insufficiency, Chronic - etiology; Renal Insufficiency, Chronic - physiopathology
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.9280

Background
Deterioration of renal function after major vascular surgery is an important complication, and may vary between patients undergoing endovascular (EVAR) or open surgical (OR) repair of an abdominal aortic aneurysm (AAA). The objective was to determine the impact of OR and EVAR on renal function after 5 years.
Methods
This was a post hoc analysis of data collected prospectively from the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial. Five years after surgery, creatinine levels were available for 189 patients (94 after OR and 95 after EVAR). The severity of renal disease was staged using the chronic kidney disease classification of the US National Kidney Foundation clinical guidelines.
Results
Using the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equation, the estimated glomerular filtration rate (eGFR) for the entire group declined over time, with a mean(s.d.) preoperative value of 80·0(7·6) ml per min per 1·73 m2 compared with 75·7(9·7) ml per min per 1·73 m2 after 5 years (mean difference 4·2 (95 per cent confidence interval 3·2 to 5·3) ml per min per 1·73 m2; P < 0·001). Five years after surgery, the mean eGFR (CKD‐EPI equation) was not significantly different between the OR and EVAR groups: 76·3(9·3) versus 75·1(10·0) ml per min per 1·73 m2 (mean difference 1·2 (−1·6 to 3·9) ml per min per 1·73 m2; P = 0·410).
Conclusion
Renal function 5 years after OR and EVAR for AAA was similar. Neither surgical procedure accelerated the loss of renal function. Registration number: NCT00421330 (http://www.clinicaltrials.gov).
No differences