• Liesa Zabrocki, Frank Marquardt, Klaus Albrecht, Andreas Kribben, and Stefan Herget-Rosenthal.
• Department of Internal Medicine, Rotes Kreuz Krankenhaus, Bremen, Germany.
• Ann Vasc Surg. 2018 Feb 1; 47: 272-278.

BackgroundPermanent renal function decline, and development and deterioration of chronic kidney disease (CKD) are associated with serious complications. How frequent is renal function decline after infrarenal abdominal aortic aneurysm (iAAA) repair according to current definitions and what are its risk factors, especially potentially modifiable ones?MethodsRetrospective observational study including all patients with elective or urgent iAAA repair from 2007 to 2011. The primary outcome was renal function decline in the first year after iAAA repair, defined as permanent reduction of estimated glomerular filtration rate (eGFR) ≥20% from baseline and/or end-stage renal disease (ESRD), all in the first year after iAAA repair. According to current Kidney Disease Improving Global Outcomes guidelines, CKD and periprocedural AKI were defined and classified. Multivariate Cox proportional hazards model was used to assess associations of the primary end point with potential risk factors.ResultsTwo hundred sixty-eight patients with iAAA repair were studied, 61 patients (22.7%) developed declining eGFR ≥20% and/or ESRD. The primary end point was independently associated with preexisting CKD (hazard ratio [HR] 3.14 [1.61-6.09]), renal artery stenosis (RAS) ≥70% (HR 4.34 [1.49-12.67]), open aortic aneurysm repair (OAR) (HR 1.69 [1.14-2.68]), and periprocedural AKI (HR 15.25 [7.49-31.05]). When comparing the subsets of patients with and without OAR and periprocedural AKI, these 2 modifiable risk factors had an additive impact. Declining eGFR ≥20% and/or ESRD was most frequent in patients receiving OAR who developed AKI.ConclusionsA permanent decline of renal function 1 year after iAAA repair is frequent. Preexisting CKD, RAS ≥70%, OAR, and periprocedural AKI are independent risk factors, the latter 2 with additive effect.Copyright © 2017 Elsevier Inc. All rights reserved.

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