Acute Kidney Injury (AKI) in Aortic Intervention: Findings From the Midlands Aortic Renal Injury (MARI) Cohort Study
Acute Kidney Injury (AKI) in Aortic Intervention: Findings From the Midlands Aortic Renal Injury (MARI) Cohort Study
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DOI：
10.1016/j.ejvs.2019.09.508
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发表时间：
2020-06-01
影响因子：
5.7
通讯作者：
Imray, Christopher H.
中科院分区：
文献类型：
--
作者：
Saratzis, Athanasios;Joshi, Shivam;Imray, Christopher H.
目的：开放式（OAR）或血管内（EVAR）主动脉修复术后急性肾损伤（AKI）的发生率尚不清楚。本研究使用经过验证的标准评估了主动脉介入治疗后发生 AKI 的患者比例，并探讨了 AKI 危险因素。 方法：这是一项多中心国家前瞻性队列研究。 11 个中心招募了接受 EVAR 或 OAR 的患者（2017 年 9 月至 2018 年 12 月）。在至少 48 小时或整个住院期间测量血清肌酐 (SCr) 和尿量，以使用肾脏疾病改善全球结果 (KDIGO) 标准定义术后 AKI。使用估计肾小球滤过率 (eGFR) 和主要肾脏不良事件 (MAKE) 30 天复合终点（包括：死亡、新透析、eGFR 下降 > 25%）计算 30 天肾功能下降。结果：纳入了 300 名患者（平均年龄：71 岁，标准差 [SD] 4 岁；9% 女性），他们接受了：肾下血管内动脉瘤修复术(EVAR) 139 例患者，开窗 EVAR (fEVAR) 30 例，分支 EVAR (bEVAR) 7 例，肾下开放性动脉瘤修复术 (OAR) 98 例，肾旁 OAR 26 例。总体而言，24% 的患者出现 1 期 AKI（根据 KDIGO 定义为 48 小时），2.7% 出现 2 期 AKI，1% 出院前需要肾脏替代治疗。每次干预的 AKI 比例为：肾下 EVAR 18%； fEVAR 27%； bEVAR 71%；肾下 OAR 41%；肾旁 OAR 63%。年龄较大（优势比[OR]：EVAR 1.44，OAR 1.58）、基线 eGFR 较低（OR 0.88 EVAR，0.74 OAR）和缺血性心脏病（OR 4.42 EVAR，5.80 OAR）是肾下 EVAR 和 OAR 发生 AKI 的主要预测因素。总体而言，24% 的人开发了 MAKE30 端点。所有一年内死亡 (0.6%) 或发生重大心脏事件 (5.6%) 的患者均发生 AKI。 结论：AKI 和主动脉介入治疗后短期肾功能下降很常见。年龄、肾功能和心血管疾病是主要危险因素。现在的研究应集中于这一高危人群的 AKI 预防。
Objective: The incidence of acute kidney injury (AKI) after open (OAR) or endovascular (EVAR) aortic repair is unknown. This research assessed the proportion of patients who develop AKI after aortic intervention using validated criteria, and explored AKI risk factors.Methods: This was a multicentre national prospective cohort study. Eleven centres recruited patients undergoing EVAR or OAR (September 2017-December 2018). Serum creatinine (SCr) and urine outputs were measured over a minimum of 48 h or throughout the index inpatient stay to define post-operative AKI using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Renal decline at 30 days was calculated using estimated glomerular filtration rate (eGFR) and the Major Adverse Kidney Events (MAKE) 30 day composite endpoint (consisting of: death, new dialysis, > 25% eGFR decline).Results: 300 patients (mean age: 71 years, standard deviation [SD] 4 years; 9% females) were included, who underwent: infrarenal endovascular aneurysm repair (EVAR) 139 patients, fenestrated EVAR (fEVAR) 30, branched EVAR (bEVAR) seven, infrarenal open aneurysm repair (OAR) 98, juxtarenal OAR 26. Overall, 24% of patients developed stage 1 AKI (defined at 48 h as per KDIGO), 2.7% stage 2 AKI and 1% needed renal replacement therapy before discharge. AKI proportions per intervention were: infrarenal EVAR 18%; fEVAR 27%; bEVAR 71%; infrarenal OAR 41%; juxtarenal OAR 63%. Older age (odds ratio [OR] 1.44 for EVAR, 1.58 for OAR), lower baseline eGFR (OR 0.88 EVAR, 0.74 OAR), and ischaemic heart disease (OR 4.42 EVAR, 5.80 OAR) were the main predictors of AKI for infrarenal EVAR and OAR. Overall, 24% developed the MAKE30 endpoint. All patients who died (0.6%) or developed a major cardiac event (5.6%) at one year had developed AKI.Conclusion: AKI and short term renal decline after aortic intervention are common. Age, renal function, and cardiovascular disease are the main risk factors. Research should now focus on AKI prevention in this high risk group.