Intraoperative Hemodynamic Parameters Related to Acute Kidney Injury in Non-ruptured Infrarenal Abdominal Aortic Aneurysm
Keywords:
Abdominal aortic aneurysm, Acute kidney injury, PerioperativeAbstract
Background: Postoperative acute kidney injury (AKI) affects up to 30% of patients after infrarenal abdominal aortic aneurysm (AAA) repair, increasing mortality, extending hospitalization, and causing long-term renal dysfunction. The specific intraoperative hemodynamic factors that influence perioperative AKI risk remain unclear. Clarifying these modifiable factors is key to developing targeted interventions to improve outcomes and reduce costs.
Objective: To determine the association between intraoperative hemodynamic parameters and perioperative acute kidney injury (AKI) in patients with non-ruptured infrarenal AAA repair.
Material and Methods: Patients underwent non-ruptured infrarenal AAA repair by open aneurysmorrhaphy and endovascular aneurysm repair (EVAR) at Thammasat University Hospital between January 2016 and October 2021. Intraoperative hemodynamic parameters and AKI by raising of creatinine (Cr) correlation were analysed by Spearman’s rank correlation test. The multivariate regression analysis determined the perioperative risk factors of AKI.
Results: 32 patients were included, with 14 patients (43.75%) in open aneurysmorrhaphy and 18 patients (56.25%) in EVAR. Peri-operative urine output < 0.5 ml/kg/min was associated with AKI in patients with non-ruptured infrarenal AAA repair (RR 11.5, 95%CI 1.49-88.27; p-value = 0.019). Immediate de-clamping or deployment of diastolic blood pressure (DBP) and mean arterial pressure (MAP) were significantly related with Cr raising by moderated correlation (DBP: ρ = 0.434, P = 0.013; MAP: ρ = 0.414, P = 0.018, respectively). De-clamping hypotension by SBP, DBP, and MAP was significantly related with Cr raising by moderated correlation (SBP: ρ = 0.471, P = 0.006; DBP: ρ = 0.609, p < 0.001; MAP: ρ = 0.612, 95%, p < 0.001), respectively).
Conclusion: Peri-operative urine output < 0.5 ml/kg/min was a risk factor of perioperative AKI. Immediate de-clamping/deployment DBP, MAP, and de-clamping hypotension were significantly correlated with peri-operative urine output and AKI in non-ruptured infrarenal AAA repair procedures. This result is a pilot data for further large multicenter prospective cohort to confirm this result.
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