Early-Stage Acute Kidney Injury Adversely Affects Thoracoabdominal Aortic Aneurysm Repair Outcomes

• Published in: The Annals of thoracic surgery Vol. 107; no. 6; pp. 1720 - 1726
• Main Authors: Chatterjee, Subhasis, LeMaire, Scott A., Amarasekara, Hiruni S., Green, Susan Y., Price, Matt D., Yanoff, Matthew S., Zhang, Qianzi, Raghavan, Rajeev, Preventza, Ourania, de la Cruz, Kim I., Coselli, Joseph S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-06-2019
• Subjects: Acute Kidney Injury - complications; Aged; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Female; Humans; Male; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - mortality; Retrospective Studies; Severity of Illness Index; Survival Rate; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2018.11.049

Acute kidney injury (AKI) necessitating renal replacement therapy adversely affects outcomes after thoracoabdominal aortic aneurysm (TAAA) repair. The effects of earlier stages of AKI are less known. We hypothesized that earlier stages of AKI would reduce early survival after TAAA repair.
We analyzed prospectively collected data from 1,056 consecutive TAAA repairs from our institution (2006 to 2016). We excluded patients less than 18 years of age, those with preexisting renal disease, and three patients who died intraoperatively, resulting in 873 patients. The Kidney Disease Improving Global Outcomes criteria grouped patients into three AKI stages; stage 3 necessitated initiation of renal replacement therapy. Multivariable modeling identified operative mortality predictors. Kaplan-Meier analysis assessed 1-year survival.
Of 873 patients, 642 (73.5%) had no AKI and 231 (26.5%) had postoperative AKI (mild/stage 1, n = 92 [10.5%]; moderate/stage 2, n = 44 [5%]; severe/stage 3, n = 95 [10.9%]). Operative death occurred in 65 patients (7.4%): 14 (2.2%) with no AKI, 5 (5.4%) with mild AKI (p = 0.07 versus no AKI), 8 (18.2%) with moderate AKI (p = 0.02 versus mild), and 38 (40%) with severe AKI (p = 0.01 versus moderate). In multivariable analysis, moderate AKI independently predicted death (relative risk ratio: 9.4, 95% confidence interval: 3.4 to 25.9). Kaplan-Meier 1-year survival was 91.1% ± 1.2% for no AKI, 84.6% ± 3.9% for mild AKI (p = 0.07 versus no AKI), 67.4% ± 7.6% for moderate AKI (p = 0.01 versus mild), and 46.6% ± 5.3% for severe AKI (p = 0.02 versus moderate; p < 0.0001 across all groups).
Moderate/stage 2 AKI reduced early survival after TAAA repair. Prevention, earlier detection, and optimal medical management of AKI may improve survival.