Acute kidney injury after elective abdominal aneurysm surgery: an evaluation of the Acute Kidney Injury Network criteria R. Mouton, 1 P. White, 2 M Elwishi1 and M. Vanarase1 1 Department of Anaesthesia, Southmead Hospital, Bristol, UK 2 University of the West of England, Bristol, UK Postoperative acute kidney injury remains a serious complication after abdominal aortic aneurysm (AAA) repair and is a major independent predictor for death after this surgery. The Acute Kidney Injury Network (AKIN) recently proposed new consensus criteria for the diagnosis of acute renal failure. The aim of our study was to evaluate acute postoperative renal impairment using AKIN criteria in patients who had undergone elective AAA repair. Methods This is a single-centre retrospective observational study of 305 consecutive patients who had undergone elective AAA repair. Patients were divided into four groups based on their postoperative kidney function: normal or AKIN category 1, 2 or 3. The association between AKIN categories and 90-day mortality was assessed using chi-square test. Binary logistic regression was used to assess the predictive ability of AKIN scores on length of intensive care unit (ICU) and hospital stay as well as 90-day mortality. Results According to the AKIN criteria, 36.7% of patients had some form of renal impairment after elective AAA repair. Of these patients, 26.2% were in AKIN category 1; 3.9% were in AKIN 2 and 6.6% were in AKIN category 3 (Table 3). The overall 90-day mortality was 7.47%. Patients with no renal impairment had a mortality of 1.2%. There was a significant association between AKIN category and 90-day mortality (p < 0.001). The AKIN category was also predictive of days spent in ICU and in hospital. Logistic regression analysis showed that patients in AKIN class 3 are 21 times more likely to have died by 90 days postoperatively compared with those with normal renal function (odds ratio = 21.3; 95% CI 3.6–125.0). Table 3. Summary of results. Values are number (proportion) or mean (SE). AKIN group 90-day mortality Hospital stay; days ICU stay; days Total Alive 0 172 170 (98.8%) 13.7 (1.1) 2.0 (0.2) 1 77 64 (83.1%) 19.6 (2.0) 4.1 (0.9) 2 12 10 (83.3%) 15.9 (2.1) 3.2 (1.0) 3 20 16 (80.0%) 25.9 (5.2) 4.3 (1.4) Discussion The AKIN criteria are a valuable method to evaluate early acute kidney injury after elective AAA repair. Early renal impairment, AKIN category 1, was associated with a significant increase in 90-day mortality compared with patients with normal kidney function. Further studies are needed to establish if early intervention improves outcomes in this patient group.
|Title of host publication||Anaesthesia|
|Publication status||Published - 2011|