Temporary Worsening of Renal Function After Aortic Surgery Is Associated With Higher Long-Term Mortality

Welten, Gijs M.J.M.; Schouten, Olaf; Chonchol, Michel; Hoeks, Sanne E.; Feringa, Harm H.H.; Bax, Jeroen J.; Dunkelgrün, Martin; van Gestel, Yvette R.B.M.; van Domburg, Ron T.; Poldermans, Don

doi:10.1053/j.ajkd.2007.04.002

« Previous Next »American Journal of Kidney Diseases
Volume 50, Issue 2 , Pages 219-228, August 2007

Temporary Worsening of Renal Function After Aortic Surgery Is Associated With Higher Long-Term Mortality

Gijs M.J.M. Welten, MD
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
Olaf Schouten, MD
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
Michel Chonchol, MD
- Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Denver, CO
Sanne E. Hoeks, MSc
- Thorax Center, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
Harm H.H. Feringa, MD
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
Jeroen J. Bax, MD
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Martin Dunkelgrün, MD
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
Yvette R.B.M. van Gestel, MSc
- Thorax Center, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
Ron T. van Domburg, PhD
- Thorax Center, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
Don Poldermans, MD
- Thorax Center, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Address correspondence to Don Poldermans, MD, Dr Molewaterplein 40, 3015 GA Rotterdam, The Netherlands.

Received 10 January 2007; accepted 4 April 2007. published online 26 May 2007.

Background

Little is known about acute changes in renal function in the postoperative period and the outcome of patients undergoing major vascular surgery. Specifically, data are scarce for patients in whom renal function temporarily decreases and returns to baseline at 3 days after surgery.

Study Design

Retrospective cohort study.

Setting & Participants

1,324 patients who underwent elective open abdominal aortic aneurysm surgery in a single center.

Predictor

Renal function (creatinine clearance was measured preoperatively and on days 1, 2, and 3 after surgery. Patients were divided into 3 groups: group 1, improved or unchanged (change in creatinine clearance, ±10% of function compared with baseline); group 2, temporary worsening (worsening > 10% at day 1 or 2, then complete recovery within 10% of baseline at day 3); and group 3, persistent worsening (>10% decrease compared with baseline).

Outcomes & Measurements

All-cause mortality.

Results

30-day mortality rates were 1.3%, 5.0%, and 12.6% in groups 1 to 3, respectively. Adjusted for baseline characteristics and postoperative complications, 30-day mortality was the greatest in patients with persistent worsening of renal function (hazard ratio [HR], 7.3; 95% confidence interval [CI], 2.7 to 19.8), followed by those with temporary worsening (HR, 3.7; 95% CI, 1.4 to 9.9). During 6.0 ± 3.4 years of follow-up, 348 patients (36.5%) died. Risk of late mortality was 1.7 (95% CI, 1.3 to 2.3) in the persistent-worsening group followed by those with temporary worsening (HR, 1.5; 95% CI, 1.2 to 1.4).

Limitations

No steady state was achieved to assess renal function.

Conclusion

Although renal function may recover completely after aortic surgery, temporary worsening of renal function was associated with greater long-term mortality.

Index Words: Renal dysfunction, survival, aortic surgery, cardiovascular disease