scholarly journals Impact of Sarcopenia on Acute Kidney Injury after Infrarenal Abdominal Aortic Aneurysm Surgery: A Propensity Matching Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2212
Author(s):  
Ji-Yeon Bang ◽  
In-Gu Jun ◽  
Jeong-Bok Lee ◽  
Yousun Ko ◽  
Kyung-Won Kim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Aortic Aneurysms ◽  
Morbidity And Mortality ◽  
Rank Test ◽  
Skeletal Muscle Index ◽  
Abdominal Aortic ◽  
Overall Mortality

Background: Sarcopenia contributes to increased morbidity and mortality in patients undergoing surgery for abdominal aortic aneurysms (AAA). However, few reports have demonstrated whether sarcopenia would affect the development of postoperative acute kidney injury (AKI) in these patients. This study aimed to examine whether sarcopenia is associated with AKI and morbidity and mortality after infrarenal AAA operation. Methods: We retrospectively analysed 379 patients who underwent infrarenal AAA surgery. The diagnosis of sarcopenia was performed using the skeletal muscle index, which was calculated from axial computed tomography at the level of L3. The patients were separated into those with sarcopenia (n = 104) and those without sarcopenia (n = 275). We applied multivariable and Cox regression analyses to evaluate the risk factors for AKI and overall mortality. A propensity score matching (PSM) evaluation was done to assess the postoperative results. Results: The incidence of AKI was greater in sarcopenia than non-sarcopenia group before (34.6% vs. 15.3%; p < 0.001) and after the PSM analysis (34.6% vs. 15.4%; p = 0.002). Multivariable analysis revealed sarcopenia to be associated with AKI before (p = 0.010) and after PSM (p = 0.016). Sarcopenia was also associated with overall mortality before (p = 0.048) and after PSM (p = 0.032). A Kaplan–Meier analysis revealed that overall mortality was elevated patients with sarcopenia before and after PSM than in those without (log-rank test, p < 0.001, p = 0.022). Conclusions: Sarcopenia was associated with increased postoperative AKI incidence and overall mortality among individuals who underwent infrarenal AAA operation.

scholarly journals Association of Early and Late Contrast-Associated Acute Kidney Injury and Long-Term Mortality in Patients Undergoing Coronary Angiography

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zhubin Lun ◽  
Jin Liu ◽  
Liwei Liu ◽  
Jingjing Liang ◽  
Guanzhong Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Cox Regression ◽  
Late Phase ◽  
Kidney Injury ◽  
Rank Test ◽  
Preoperative Serum ◽  
Increased Risk ◽  
Long Term Mortality

Background. Contrast-associated acute kidney injury (CA-AKI) is a common complication in patients undergoing coronary angiography (CAG). However, few studies demonstrate the association between the prognosis and developed CA-AKI in the different periods after the operation. Methods. We retrospectively enrolled 3206 patients with preoperative serum creatinine (Scr) and at least twice SCr measurement after CAG. CA-AKI was defined as an increase ≥50% or ≥0.3 mg/dL from baseline in the 72 hours after the procedure. Early CA-AKI was defined as having the first increase in SCr within the early phase (<24 hours), and late CA-AKI was defined as an increase in SCr that occurred for the first time in the late phase (24–72 hours). The first endpoint of this study was long-term all-cause mortality. Kaplan–Meier analysis was used to count the cumulative mortality, and the log-rank test was used to assess differences between curves. Univariate and multivariate cox regression analyses were performed to assess whether patients who developed different type CA-AKI were at increased risk of long-term mortality. Results. The number of deaths in the 3 groups was 407 for normal (12.7%), 106 for early CA-AKI (32.7%) and 57 for late CA-AKI (17.7%), during a median follow-up period of 3.95 years. After adjusting for important clinical variables, early CA-AKI (HR = 1.33, 95% CI: 1.02–1.74, P = 0.038 ) was significantly associated with mortality, while late CA-AKI (HR = 0.92, 95% CI: 0.65–1.31, P = 0.633 ) was not. The same results were found in patients with coronary artery disease, chronic kidney disease, diabetes mellitus, and percutaneous coronary intervention. Conclusions. Early increases in Scr, i.e., early CA-AKI, have better predictive value for long-term mortality. Therefore, in clinical practice, physicians should pay more attention to patients with early renal injury related to long-term prognosis and give active treatment.

scholarly journals Comparison of urine and serum neutrophil gelatinase-associated lipocalin after open and endovascular thoraco-abdominal aortic surgery and their meaning as indicators of acute kidney injury

VASA ◽  
2019 ◽  
Vol 48 (1) ◽  
pp. 79-87 ◽  
Author(s):  
Alexander Gombert ◽  
Lukas Martin ◽  
Ann Christina Foldenauer ◽  
Clara Krajewski ◽  
Andreas Greiner ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Aortic Aneurysms ◽  
Urine Ngal ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Abdominal Aortic ◽  
Potential Biomarker ◽  
Significant Difference ◽  
Neutrophil Gelatinase

Abstract. Background: Neutrophil gelatinase-associated lipocalin (NGAL) has been described as a potential biomarker of acute kidney injury (AKI) in different settings, but its behaviour under influence of open and endovascular repair of thoraco-abdominal aortic aneurysms (TAAA) has not been assessed yet. In this study, the course of NGAL was observed and differences of serum- (sNGAL) and urine-NGAL (uNGAL) levels following TAAA repair, especially with regard to AKI, were evaluated. Patients and methods: In this retrospective single centre study, 52 patients (mean age 64.5 years, [43–85 years]), including 39 (75 %) men, were enrolled (2014–2015, 13.2 months mean follow-up). Levels of sNGAL and uNGAL were measured perioperatively for 48 hours on intensive care unit. Twenty-three patients were treated by endovascular and 29 by open TAAA-repair. Results: Logistic regression revealed an increase in NGAL (sNGAL p = 0.0263, uNGAL p = 0.0080) corresponding with an increase in serum creatinine within the first 48 hours. Fourteen patients (26.9 %) developed AKI and 11 (21.1 %) required dialysis. The course of NGAL differed significantly (uNGAL p < .0001, sNGAL p = 0.0002) between patients suffering from AKI requiring dialysis and patients without AKI. The predictive power of uNGAL was three times higher than that of sNGAL (estimate of the regression slope 0.1382 vs. 0.0460). No significant difference between patients undergoing open or endovascular TAAA repair regarding the perioperative course of sNGAL and uNGAL was observed. Conclusion: serum-NGAL and urine-NGAL correlate with serum creatinine levels and AKI requiring dialysis. Furthermore, the postoperative course of sNGAL and uNGAL after open and endovascular TAAA repair is not significantly different. Taken together, the results indicate that uNGAL and, to a lesser extent, sNGAL could be considered biomarkers for early detection of perioperative AKI after open and endovascular TAAA surgery.

Acute Kidney Injury after Complex Endovascular Aneurysm Repair

2020 ◽  
Vol 25 (44) ◽  
pp. 4686-4694 ◽  
Author(s):  
Nathan L. Liang ◽  
Abhisekh Mohapatra ◽  
Efthymios D. Avgerinos ◽  
Athanasios Katsargyris
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Aneurysm ◽  
Endovascular Repair ◽  
Associated Factors ◽  
Endovascular Aneurysm Repair ◽  
Kidney Injury ◽  
Aortic Aneurysms ◽  
Perioperative Morbidity ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Background: Complex endovascular repair of abdominal aortic aneurysm carries higher perioperative morbidity than standard infrarenal endovascular repair. Objective: This study reviews the incidence and associated factors of acute kidney injury in complex aortic endovascular repair of juxtarenal, pararenal, and thoracoabdominal aortic aneurysms. Methods: A literature review was performed for all studies on the endovascular repair of juxtarenal, pararenal, and thoracoabdominal aneurysms that evaluated rates of acute kidney injury as an outcome. Outcomes were further analyzed by the level of anatomic complexity and method of repair. Results: 52 studies met inclusion criteria, with a total of 5454 individuals undergoing repair from 2004 to 2017. The overall rate of acute kidney injury ranged widely from 0 to 41%, with a rate of hemodialysis from 0 to 19% (temporary) and 0 to 14% (permanent). Increasing anatomic complexity was associated with higher rates of acute kidney injury. Mode of endovascular repair, learning curve effect, and preoperative chronic renal insufficiency did not demonstrate any associations with the outcome. Conclusion: Published rates of acute kidney injury in complex aortic aneurysm repair vary widely with few definitively associated factors other than increasing anatomic complexity and operative time. Further study is needed for the identification of predictors related to postoperative acute kidney injury.

scholarly journals Acute Kidney Injury at Hospital Admission for SARS-CoV-2 Infection as a Marker of Poor Prognosis: Clinical Implications for Triage Risk Stratification

2022 ◽  
pp. 1-4
Author(s):  
Carlo Andrea Bravi ◽  
Walter Cazzaniga ◽  
Marco Simonini ◽  
Alessandro Larcher ◽  
Elisabetta Messaggio ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Risk Stratification ◽  
Hospital Admission ◽  
Poor Prognosis ◽  
Cox Regression ◽  
Wide Spectrum ◽  
Kidney Injury ◽  
Prognostic Indicator ◽  
Increased Risk ◽  
Overall Mortality

<b><i>Background/Aims:</i></b> The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a wide spectrum of effects, including acute kidney injury (AKI) in up to 40% of hospitalized patients. Given the established relationship between AKI and poor prognosis, whether AKI might be a prognostic indicator for patients admitted to the hospital for SARS-CoV-2 infection would allow for a straightforward risk stratification of these patients. <b><i>Methods:</i></b> We analyzed data of 623 patients admitted to San Raffaele Hospital (Milan, IT) between February 25 and April 19, 2020, for laboratory-confirmed SARS-CoV-2 infection. Incidence of AKI at hospital admission was calculated, with AKI defined according to the KDIGO criteria. Multivariable Cox regression models assessed the association between AKI and overall mortality and admission to the intensive care unit (ICU). <b><i>Results:</i></b> Overall, 108 (17%) patients had AKI at hospital admission for SARS-CoV-2 infection. After a median follow-up for survivors of 14 days (interquartile range: 8, 23), 123 patients died, while 84 patients were admitted to the ICU. After adjusting for confounders, patients who had AKI at hospital admission were at increased risk of overall mortality compared to those who did not have AKI (hazards ratio [HR]: 2.00; <i>p</i> = 0.0004), whereas we did not find evidence of an association between AKI and ICU admission (HR: 0.95; <i>p</i> = 0.9). <b><i>Conclusions:</i></b> These data suggest that AKI might be an indicator of poor prognosis for patients with SARS-CoV-2 infection, and as such, given its readily availability, it might be used to improve risk stratification at hospital admission.

scholarly journals Impact of Acute Kidney Injury on Survival in Patients With Chronic Hepatitis C

2020 ◽  
Author(s):  
Hankyu Jeon ◽  
Jae Heon Kim ◽  
Sang Soo Lee ◽  
Hee Jin Kim ◽  
Ra Ri Cha ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Cox Regression ◽  
Kidney Injury ◽  
Hcv Infection ◽  
Decompensated Cirrhosis ◽  
Cox Regression Analysis ◽  
Overall Mortality

Abstract Background: Acute kidney injury (AKI) is expected to occur commonly in patients with chronic hepatitis C. In addition, AKI may affect the survival of patients with chronic hepatitis C. However, few studies are available on this topic. We aimed to evaluate the incidence of AKI in patients with chronic hepatitis C and investigate the factors related to overall mortality. Methods: Between January 2005 and December 2018, 1252 patients with chronic hepatitis C virus (HCV) infection were retrospectively enrolled at two centers. Of them, 1008, 123, and 121 patients had chronic hepatitis (CH), compensated cirrhosis (Com-LC), and decompensated cirrhosis (Decom-LC) or hepatocellular carcinoma (HCC) at entry, respectively. Results: Over a mean follow-up period of 5.2 years, 285 patients developed AKI, with an incidence rate of 4.35 per 100 person-years. The incidence of AKI increased gradually with progression of chronic hepatitis C: CH (3.32 per 100 person-years), Com-LC (5.86 per 100 person-years), and Decom-LC or HCC (17.28 per 100 person-years). Patients without AKI showed a better survival rate than patients with AKI (P < 0.001). In multivariate Cox regression analysis, AKI (hazard ratio, 6.66; 95% confidence interval, 4.26–10.41) remained an independent risk factor for overall mortality. Conclusion: AKI is common in patients with chronic HCV infection and is associated with significant overall mortality. Therefore, clinicians should carefully monitor the occurrence of AKI, which is an important predictor of mortality in patients with chronic hepatitis C.

Acute Kidney Injury after Open Repair of Intact Abdominal Aortic Aneurysms

2017 ◽  
Vol 39 ◽  
pp. 294-300 ◽  
Author(s):  
Charles Dariane ◽  
Raphaël Coscas ◽  
Celia Boulitrop ◽  
Isabelle Javerliat ◽  
Eve Vilaine ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Open Repair ◽  
Kidney Injury ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic

A comparison of endovascular versus open repair for ruptured abdominal aortic aneurysm – Meta-analysis of propensity score-matched data

Vascular ◽  
2021 ◽  
pp. 170853812110251
Author(s):  
Hatim Alsusa ◽  
Abbas Shahid ◽  
George A Antoniou
Keyword(s):  
Open Repair ◽  
Meta Analysis ◽  
Endovascular Aneurysm Repair ◽  
Kidney Injury ◽  
The Body ◽  
Aortic Aneurysms ◽  
Perioperative Outcomes ◽  
Perioperative Mortality ◽  
Abdominal Aortic ◽  
Overall Mortality

Background Optimal management of ruptured abdominal aortic aneurysms (rAAA) has been heavily debated in the literature. The aim of this review is to assess comparative outcomes from propensity-matched studies of endovascular versus open for rAAA. Methods Electronic databases (MEDLINE and Embase) were searched in January 2021 using the Healthcare Databases Advanced Search interface. Eligible studies compared endovascular versus open repair for rAAA using propensity-matched cohorts. Pooled estimates of perioperative outcomes were calculated using odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) using the random-effects model. Time-to-event data meta-analysis was conducted using the inverse-variance method and reported as summary hazard ratio (HR) and associated 95% CI. The quality of evidence was graded using a system developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group. Results Six studies published between 2010 and 2020 were selected for qualitative and quantitative synthesis, reporting a total of 6731 patients. The odds of perioperative mortality after endovascular aneurysm repair (EVAR) were significantly lower than after open surgical repair (OSR) (OR 0.52, 95% CI 0.41–0.65). The hazard of overall mortality during follow-up was lower, although not significantly, after EVAR than after OSR (HR 0.79, 95% CI 0.62–1.01). The odds of acute kidney injury and early aneurysm-related reintervention were both significantly lower after EVAR than after OSR (OR 0.34, 95% CI 0.14–0.78 and OR 0.57, 95% CI 0.33–0.98, respectively). Patients treated with EVAR stayed in hospital for significantly less time than those treated with OSR (MD −5.13, 95% CI −7.94 to −2.32). The certainty of the body of evidence for perioperative mortality was low and for overall mortality was very low. Conclusion The evidence suggests that EVAR confers a significant benefit on perioperative mortality.

scholarly journals Acute kidney injury after open and endovascular elective repair for infrarenal abdominal aortic aneurysms

2016 ◽  
Vol 64 (4) ◽  
pp. 928-933.e1 ◽  
Author(s):  
Claudio Castagno ◽  
Gianfranco Varetto ◽  
Simone Quaglino ◽  
Edoardo Frola ◽  
Gitana Scozzari ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Elective Repair
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