Highlights
- •Patients undergoing elective EVAR are at risk of contrast associated acute kidney injury (CA-AKI)
- •Patients with decreased renal function (GFR < 30 ml/min) are at higher risk of CA-AKI after EVAR
- •Patients with a maximum AAA diameter above 6.9 cm are at higher risk of CA-AKI after EVAR
- •Female patients regardless of maximum AAA diameter are at higher risk of CA-AKI after EVAR
Abstract
Objectives
Contrast-associated acute kidney injury (CA-AKI) after endovascular abdominal aortic
aneurysm repair (EVAR) is associated with mortality and morbidity. Risk stratification
remains a vital component of preoperative evaluation. We sought to generate and validate
a pre-procedure CA-AKI risk stratification tool for elective EVAR patients.
Methods
We queried the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
database for elective EVAR patients and excluded those on dialysis, with a history
of renal transplant, death during procedure, and without creatinine measures. Association
with CA-AKI (rise in creatinine > 0.5 mg/dL) was tested using mixed effects logistic
regression. Variables associated with CA-AKI were used to generate a predictive model
via a single classification tree. The variables selected by the classification tree
were then validated by fitting a mixed effects logistic regression model into the
Vascular Quality Initiative (VQI) dataset.
Results
Our derivation cohort included 7,043 patients, 3.5% of whom developed CA-AKI. After
multivariate analysis, age (OR 1.021, 95% CI 1.004-1.040), female sex (OR 1.393, CI
1.012-1.916), GFR < 30 ml/min (OR 5.068, CI 3.255-7.891), current smoking (OR 1.942,
CI 1.067-3.535), COPD (OR 1.402, CI 1.066-1.843), maximum AAA diameter (OR 1.018,
CI 1.006-1.029), and presence of iliac artery aneurysm (OR 1.352, CI 1.007-1.816)
were associated with increased odds of CA-AKI. Our risk prediction calculator demonstrated
that patients with a GFR <30 ml/min, females, and patients with a maximum AAA diameter
of > 6.9 cm are at higher risk of CA-AKI after EVAR. Using the VQI dataset (N = 62,986),
we found that GFR <30 ml/min (OR 4.668, CI 4.007-5.85), female sex (OR 1.352, CI 1.213-1.507),
and maximum AAA diameter > 6.9 cm (OR 1.824, CI 1.212-1.506) were associated with
increased risk of CA-AKI after EVAR.
Conclusions
Herein, we present a simple and novel risk assessment tool that can be used pre-operatively
to identify patients at risk of CA-AKI after EVAR. Patients with a GFR < 30 ml/min,
maximum AAA diameter > 6.9 cm, and females who are undergoing EVAR may be at risk
for CA-AKI after EVAR. Prospective studies are needed to determine the efficacy of
our model.
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Article info
Publication history
Accepted:
February 13,
2023
Received in revised form:
February 9,
2023
Received:
January 10,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Presentation Information: This study was presented at the Midwestern Vascular Surgical Society Annual Meeting, Grand Rapids, MI, September 15th-17th 2022
Identification
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