Preventive Strategies for Acute Kidney Injury among Patients Undergoing Abdominal Aortic Aneurysm Repair
Abstract
Strategies for preventing acute kidney injury (AKI) in patients undergoing abdominal aortic aneurysm (AAA) repair were explored in a secondary data analysis of 601 patients from a randomized controlled trial (RCT). Bivariate analyses identified an association between intraoperative hypotension and postoperative AKI and suggested IV fluids as the best treatment option over inotropes/vasopressors which increased the odds of AKI (ORcrude=2.5 95%CI 1.2-5.0), however, our multivariable analysis was non-significant (ORadjusted=1.7 95%CI 0.8-3.7). Further analysis found angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use within 24 hours prior to repair were not associated with postoperative AKI (ORadjusted=1.3 95%CI 0.8-2.2). Our systematic review of RCT literature failed to identify any definitive evidence for effective preventive strategies, andour meta-analysis of 6 RCTs analyzing remote-ischemic preconditioning showed no statistically significant difference (OR 1.2 95%CI 0.4-3.9). Large, multi-centre RCTs are needed to identify preventive strategies for AKI after AAA repair.