Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention

Eur J Vasc Endovasc Surg. 2017 May;53(5):717-724. doi: 10.1016/j.ejvs.2017.01.014. Epub 2017 Mar 18.

Abstract

Background: Acute kidney injury (AKI) is a common complication after endovascular intervention, associated with poor short and long-term outcomes. However, the mechanisms underlying AKI development remain poorly understood. The impact of pre-existing cardiovascular disease and low cardiovascular reserve (CVR) in AKI is unclear; it remains unknown whether AKI is primarily related to pre-existing comorbidity or to procedural parameters. The association between CVR and AKI after EVAR was therefore assessed.

Methods: This is a case control study. From a database of 484 patients, 292 undergoing elective endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA) in two tertiary centres were included. Of these, 73 patients who had developed AKI after EVAR were case matched, based on pre-operative estimated glomerular filtration rate (eGFR; within 5 mL/min/1.73 m2) and age, with patients who had not developed AKI. Cardiopulmonary exercise testing (CPET) was used to assess CVR using the anaerobic threshold (AT). Development of AKI was defined using the Kidney Disease Improving Outcomes (KDIGO) guidance. Associations between CVR (based on AT levels) and AKI development were then analysed.

Results: Pre-operative AT levels were significantly different between those who did and did not develop AKI (12.1±2.9 SD vs. 14.8±3.0 mL/min/kg, p < .001). In multivariate analysis, a higher level of AT (per 1 mL/min/kg) was associated with a lower odds ratio (OR) of 0.72 (95% CI, 0.63-0.82, p < .001), relative to AKI development. A pre-operative AT level of < 11 mL/min/kg was associated with post-operative AKI development in adjusted analysis, with an OR of 7.8 (95% CI, 3.75-16.51, p < .001). The area under the curve (receiver operating characteristic) for AT as a predictor of post-operative AKI was 0.81 (standard error, 0.06, 95% CI, 0.69-0.93, p < .001).

Conclusions: Poor CVR was strongly associated with the development of AKI. This provides pathophysiological insights into the mechanisms underlying AKI.

Keywords: Acute kidney injury; Acute renal failure; Cardiovascular reserve; Risk factor.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / physiopathology
  • Aged
  • Aged, 80 and over
  • Anaerobic Threshold
  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / physiopathology
  • Aortic Aneurysm, Abdominal / surgery*
  • Cardiorespiratory Fitness*
  • Chi-Square Distribution
  • Databases, Factual
  • Endovascular Procedures / adverse effects*
  • England
  • Exercise Test
  • Female
  • Glomerular Filtration Rate
  • Health Status
  • Humans
  • Kidney / physiopathology
  • Linear Models
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Tertiary Care Centers
  • Time Factors
  • Treatment Outcome