Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

Nobu Yokoyama; Takao Nonaka; Naoyuki Kimura; Yusuke Sasabuchi; Daijiro Hori; Wataru Matsunaga; Tomonari Fujimori; Kosuke Miyoshi; Harunobu Matsumoto; Atsushi Yamaguchi

doi:10.3400/avd.oa.19-00095

Acute Kidney Injury Following Elective Open Aortic Repair with Suprarenal Clamping

Ann Vasc Dis. 2020 Mar 25;13(1):45-51. doi: 10.3400/avd.oa.19-00095.

Affiliations

¹ Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.
² Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan.
³ Department of Anesthesiology, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.

Abstract

Objective: To investigate predictors of acute kidney injury (AKI) following open aortic repair (OAR) requiring suprarenal clamping. Methods: The study included 833 nonhemodialysis patients who had undergone elective OAR (with suprarenal clamping, n=73; with infrarenal clamping, n=760). We evaluated AKI as defined by the criteria of the Kidney Disease Improving Global Outcomes (KDIGO) and compared in-hospital outcomes between the two groups. We also investigated the effects of AKI on outcomes, factors related to post-suprarenal clamping AKI, and efficacy of hypothermic renal perfusion (HRP) in the suprarenal clamping group. Results: For the suprarenal vs. infrarenal clamping group, in-hospital mortality was 0% (0/73) vs. 0.5% (4/760). The incidence of AKI was greater in the suprarenal clamping group (37% vs. 15%, P<0.001), and the hospital stay for patients with AKI was longer than for those patients without AKI (median, 21 days vs. 16 days; P=0.005). Renal ischemia time and bleeding volume >1,000 mL were associated with post-suprarenal clamping AKI. Renal ischemia time was longer with HRP (n=15) than without HRP (n=58) (median, 51 min vs. 33 min; P=0.011), and HRP did not decrease the incidence of AKI (40% vs. 36%; P=0.78). Conclusion: Prolonged renal ischemia and substantial intraoperative bleeding are associated with postoperative AKI following suprarenal clamping.

Keywords: abdominal aortic aneurysm; acute kidney injury; suprarenal clamping.