Preview

Nephrology (Saint-Petersburg)

Advanced search

Acute kidney injury in patient with aortofemoral reconstruction: focus on operative intervention

Abstract

THE AIM: to find operative intervention indicators are forming surgery risk factor of acute kidney injury (AKI) after aortofemoral reconstruction (AFR) and to predict individual creatininemia level in postoperative period. PATIENTS AND METHODS: We performed medical record of 82 patients with different forms of aortofemoral segment pathology, which had AFR surgical intervention in 2007 and 2008. For diagnose AKI we used AKIN (Acute Kidney Injury Network) score. All patients were dividing into to groups: group 1 (n=64) without AKI, and group 2 (n=18) with AKI. We used a descriptive statistics, correlation and regression statistical analysis. RESULTS: In patient which had had surgical intervention the real AKI rate was 21,9% (95% CI 11,7%>-32,1%>) in contrast with recorded cases of AKI (95% CI 0,9%>-8,4%>). Patient with AKI had higher (p<0,05) blood loss level in operation time and received more infusion therapy volume (blood cell reinfusion, blood components and colloid infusion). The regression model of maximum creatininemia level during 72 hours after aortofemoral reconstruction was shown. CONCLUSION: Operative risk factor with other factors is increasing a developing of AKI from patients undergoing aortofemoral reconstructions. The proprieties (speed and volume) of intraoperative blood loss are a main factor of this. The regression model, based on standard indicators (blood creatinin level before the surgical intervention, infusion therapy volume, aorta clamping time) will help to set a maximum level of creatinenemia during the first three days after reconstruction. Prediction of the maximum level creatinenemia in the postoperative period will provide an opportunity to advance to assume development AKI with a specific patient, which should attract additional attention to the medical staff in this category of patients.

About the Authors

Oleg A. Nagibovich
Research centre
Russian Federation


Kirill V. Kitachov
Medical Academy named after S.M. Kirov
Russian Federation


R. O. Nagibovich
Medical Academy named after S.M. Kirov
Russian Federation


References

1. Coca SG, Yusuf B, Shlipak MG et al. Long-term Risk of Mortality and Other Adverse Outcomes After Acute Kidney Injury: A Systematic Review and Meta-analysi. Am J Kidney Dis 2009; 53(6): 961-973

2. Zeng X, McMahon GM, Bates DW, Waikar SS. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 2014; 9(1): 12-20

3. Myers SI. Systemic Complications - Renal. In Cronenwett JL, Johnston KW; Rutherford’s vascular surgery, 7th ed. Saunders Elsevier. (PA, US), 2010; 627-642

4. Black SA, Brooks MJ, Naidoo MN, Wolfe JHN. Assessing the Impact of Renal Impairment on Outcome after Arterial Intervention: A Prospective Review of 1559 Patients. Eur J Vasc Endovasc Surg 2006; 32(3): 300-304

5. Трухачева НВ. Математическая статистика в медико-биологических исследованиях с применением пакета Statistica. ГЭОТАР-Медиа, М., 2013; 384 с. [Truhacheva NV Matematicheskajа statistika v mediko-biologicheskih issledovanijаh s primeneniem paketa Statistica. GYeOTAR-Media, M., 2013; 384 s.]

6. Смирнов АВ, Каюков ИГ, Добронравов ВА и др. Проблемы диагностики и стратификации тяжести острого повреждения почек. Нефрология 2009; (3): 9-18 [Smirnov AV, Kaiukov IG, Dobronravov VA i dr. Problemy' diagnostiki i stratifikatcii tiazhesti ostrogo povrezhdeniia pochek. Nefrologiia 2009; (3): 9-18]

7. De Bruin JL, Vervloet MG, Buimer MG et al. DrEAM Study Group. Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial. Br J Surg 2013; 100(11): 1465-1470

8. Смирнов АВ, Добронравов ВА, Румянцев АШ и др. Национальные рекомендации. Острое повреждение почек: основные принципы диагностики, профилактики и терапии. Часть 1. Нефрология 2016; (1): 79-104 [Smirnov AV, Dobronravov VA, Rumjаncev ASH i dr. Nacional'nye rekomendacii. Ostroe povrezhdenie pochek: osnovnye principy diagnostiki, profilaktiki i terapii. CHast' 1. Nefrologija 2016; (1): 79-104]

9. Покровский АВ, Чихарев МВ. Почечные осложнения при реконструкции брюшной аорты. В кн.: Покровский АВ, ред. Клиническая ангиология. Практическое руководство в 2-х томах. Медицина, М., 2004; Т. 2., С. 86-93 [Pokrovskii' AV, Chiharev MV. Pochechny'e oslozhneniia pri rekonstruktcii briushnoi' aorty'. V: Pokrovskii' AV, red. Clinicheskaia angiologiia. Prakticheskoe rukovodstvo v 2-kh tomakh. Meditcina, M., 2004; T. 2., S 86-93]

10. Thakar CV, Arrigain S, Worley S. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol 2005; 16(1): 162-168

11. Смирнов АВ, Добронравов ВА, Румянцев АШ и др. Национальные рекомендации. Острое повреждение почек: основные принципы диагностики, профилактики и терапии. Часть 2. Нефрология 2016; (2): 86-100 [Smirnov AV, Dobronravov VA, Rumjаncev ASH i dr. Nacional'nye rekomendacii. Ostroe povrezhdenie pochek: osnovnye principy diagnostiki, profilaktiki i terapii. CHast' 2. Nefrologijа 2016; (2): 86-100]

12. Kim GS, Ahn HJ, Kim WH et al. Risk factors for postoperative complications after open infrarenal abdominal aortic aneurysm repair in Koreans. Yonsei Med J 2011; 52(2): 339-346

13. Kopolovic I, Simmonds K, Duggan S et al. Risk factors and outcomes associated with acute kidney injury following ruptured abdominal aortic aneurysm. BMC Nephrology 2013; 14 Art 99: 9 p

14. Китачев КВ, Хубулава ГГ, Нагибович ОА и др. Влияние срочности выполнения аорто-бедренных реконструкций на повреждение почек. Бюллютень НЦССХ им. А.Н. Бакулева РАМН сердечно-сосудистые заболевания 2015; 16(6) (Приложение): 119 [Kitachev KV, Hubulava GG, Nagibovich OA i dr. Vlijanie srochnosti vypolnenija aorto-bedrennyh rekonstrukcij na povrezhdenie pochek. Bjulljuten' NCSSH im. A.N. Bakuleva RAMN serdechno-sosudistye zabolevanija 2015; 16(6) (Prilozhenie): 119]

15. Svensson LG, Crawford ES, Hess KR et al. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 1993; 17(2): 357-370

16. El-Sabrout RA, Reul GJ, Cooley DA. Outcome after simultaneous abdominal aortic aneurysm repair and aortocoronary bypass. Ann Vasc Surg 2002; 16(3): 321-330

17. Chiesa R, Tshomba Y Psacharopulo D et al. Open repair for infrarenal AAA: technical aspects. J Cardiovasc Surg (Torino) 2012; 53(1 Suppl 1): 119-131

18. Georgakis P, Paraskevas KI, Bessias N et al. Duration of aortic cross-clamping during elective open abdominal aortic aneurysm repair operations and postoperative cardiac/renal function. Inf Angiol 2010; 29(3): 244-248

19. Prowle JR, Chua HR, Bagshaw SM, Bellomo R. Clinical review: Volume of fluid resuscitation and the incidence of acute kidney injury - a systematic review. Critical Care 2012; 16(4): 230: 15 p

20. Pelkay TJ, Frank RS, Stanley JJ et al. Minimal physiologic temperature variations during renal ischemia alter functional and morphologic outcome. J Vasc Surg 1992; 15(4): 619-625

21. Хубулава ГГ, Сазонов АБ. Хирургическое лечение аневризм инфраренального отдела аорты. Наука, СПб., 2009; 90-127 [Hubulava GG, Sazonov AB. Hirurgicheskoe lechenie anevrizm infrarenal'nogo otdela aorty'. Nauka SPb., 2009; 90-127]

22. Nathan DP, Brinster CJ, Jackson BM et al. Predictors of decreased short- and long-term survival following open abdominal aortic aneurysm repair. J Vasc Surg 2011; 54: 1237-1243


Review

For citations:


Nagibovich O.A., Kitachov K.V., Nagibovich R.O. Acute kidney injury in patient with aortofemoral reconstruction: focus on operative intervention. Nephrology (Saint-Petersburg). 2016;20(4):72-79. (In Russ.)

Views: 552


ISSN 1561-6274 (Print)
ISSN 2541-9439 (Online)