The aim of this cohort study was to report the proportion of patients who develop periprocedural acute kidney injury (AKI) after endovascular repair (ER) and open surgery (OS) in patients with juxta/pararenal abdominal aortic aneurysm and to assess potential risk factors for AKI. The study also aimed to report the short- and long-term outcomes of patients with and without AKI. This was a multicenter cohort study of five European academic high-volume centers (>50 OS or 50 ER infrarenal AAA repairs, plus >15 complex AAA repairs per year). All consecutively treated patients were extracted from a prospective vascular surgical registry and the data were scrutinized retrospectively. The primary end point for this study was the development of AKI. AKI was diagnosed when there is a two-fold increase of serum creatinine or decrease of glomerular filtration rate of >50% within 1 week of AAA repair. Secondary end points included long-term mortality and end-stage renal disease (ESRD). AKI occurred in 16.6% of patients in the ER group vs 30.3% in the OS group ( < .001). The 30-day mortality rate was higher among patients with AKI in both ER (15.4% vs 3.1%; = .006) and OS (13.2% vs 5.3%; = .001) groups. Age, chronic kidney disease, presence of significant thrombus burden in the pararenal region, >1000 mL blood loss in ER group were associated with development of AKI. Age, diabetes mellitus, chronic kidney disease, presence of significant thrombus burden in the pararenal region, and a proximal clamping time of >30 minutes in the OS group were associated with the development of AKI, whereas renal perfusion during clamping was the protective factor against AKI development. After a median follow-up of 91 months, AKI was associated with higher mortality rates in both the ER group (58.9% vs 29.7%; < .001) and the OS group (61.5% vs 27.3%; < .001). After the same follow-up period, AKI was associated with a higher incidence of ESRD in both the ER group (12.8% vs 3.6%; = .009) and the OS group (9.9% vs 2.9%; < .001). The current study identified important pre and postoperative factors associated with AKI after juxta/pararenal abdominal aortic aneurysm repair. Patients with postoperative AKI had significantly higher short- and long term mortality and higher incidence of ESRD than patients without AKI.

中文翻译：

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接受肾旁或肾旁主动脉瘤血管内或开放修复术的患者的急性肾损伤

本队列研究的目的是报告近肾旁/肾旁腹主动脉瘤患者在血管内修复（ER）和开放手术（OS）后发生围手术期急性肾损伤（AKI）的患者比例，并评估潜在的危险因素。急性肾损伤。该研究还旨在报告患有和不患有 AKI 的患者的短期和长期结果。这是一项针对五个欧洲学术大容量中心的多中心队列研究（> 50 例 OS 或 50 例 ER 肾下 AAA 修复，加上每年 > 15 例复杂 AAA 修复）。所有连续治疗的患者均从前瞻性血管外科登记处提取，并对数据进行回顾性审查。本研究的主要终点是 AKI 的发生。当 AAA 修复后 1 周内血清肌酐增加两倍或肾小球滤过率下降 > 50% 时，可诊断 AKI。次要终点包括长期死亡率和终末期肾病（ESRD）。 ER 组中有 16.6% 的患者发生 AKI，而 OS 组中有 30.3% 的患者发生 AKI (< .001)。 ER（15.4% vs 3.1%；= .006）和 OS（13.2% vs 5.3%；= .001）组中 AKI 患者的 30 天死亡率较高。年龄、慢性肾脏病、肾旁区域存在显着血栓负荷、ER 组失血量 >1000 mL 与 AKI 的发生相关。年龄、糖尿病、慢性肾病、肾旁区域存在显着血栓负荷以及 OS 组近端钳夹时间 > 30 分钟与 AKI 的发生相关，而钳夹期间的肾灌注是 AKI 发生的保护因素AKI 的发展。中位随访 91 个月后，AKI 与 ER 组（58.9% vs 29.7%；< .001）和 OS 组（61.5% vs 27.3%；< .001）的较高死亡率相关。在相同的随访期后，ER 组（12.8% vs 3.6%；= .009）和 OS 组（9.9% vs 2.9%；< .001）中 ​​AKI 与 ESRD 发生率较高相关。目前的研究确定了与肾旁/肾旁腹主动脉瘤修复术后 AKI 相关的重要术前和术后因素。术后发生 AKI 的患者比无 AKI 的患者显着更高的短期和长期死亡率以及 ESRD 的发生率。