Dariane Charles, Coscas Raphaël, Boulitrop Celia, Javerliat Isabelle, Vilaine Eve, Goeau-Brissonniere Olivier, Coggia Marc, Massy Ziad A
Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France.
Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France; CESP, INSERM U-1018 Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Université Paris-Saclay, Hôpital Paul Brousse, Villejuif Cedex, France.
Ann Vasc Surg. 2017 Feb;39:294-300. doi: 10.1016/j.avsg.2016.09.010. Epub 2016 Nov 24.
These last years, considerable attention has been given to renal issues following endovascular aortic repair but acute kidney injury (AKI) also remains one of the most frequent complications following open repair (OR). Since AKI definition has evolved, our aim was to review the etiology, incidence, classifications, and consequences of AKI after OR for intact abdominal aortic aneurysm (AAA).
A review of the English language literature published between 2004 and 2016 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Studies regarding ruptured AAA, combination of emergency and elective repairs without results stratification, and thoracoabdominal aneurysms were excluded, as well as studies not using recent consensual AKI classifications.
In total, 6 studies including 658 patients (394 from prospective studies and 264 from retrospective studies) used recent consensual classifications (risk injury failure loss end-stage renal disease [RIFLE], Acute Kidney Injury Network classification [AKIN], kidney disease-improving global outcomes [KDIGO], and Aneurysm Renal Injury Score [ARISe]) and were considered for analysis. After infrarenal clamping, AKI rates were quite similar between studies, observed in 24% cases when using the RIFLE classification, 20% cases with the AKIN criteria, and 26.3% cases when using the ARISe classification. Pooled rates of renal replacement therapy (RRT) and 30-day mortality were 0.3% and 1.4%, respectively. In the long term, no patient mandated chronic RRT. After suprarenal clamping, 2 retrospective studies used the RIFLE criteria to define the incidence of AKI, and the pooled AKI rate was 36.8%. The AKI rate was 26.5% in smaller retrospective study using the KDIGO criteria. Rates of RRT and 30-day mortality were 3.8% and 2.9%, respectively. In the long term, 1.2-3% of patients mandated chronic RRT.
AKI is a common but generally transient complication after OR for AAA. Its incidence depends on definitions used, and few studies were found to use recent consensual AKI criteria. In the future, large prospective studies using consensual AKI definitions will facilitate comparison between repair strategies.
近年来，血管腔内主动脉修复术后的肾脏问题受到了广泛关注，但急性肾损伤（AKI）仍是开放修复（OR）术后最常见的并发症之一。由于AKI的定义已经演变，我们的目的是回顾完整腹主动脉瘤（AAA）开放修复术后AKI的病因、发病率、分类及后果。
根据系统评价和Meta分析的首选报告项目（PRISMA）标准，对2004年至2016年发表的英文文献进行综述。排除关于破裂性AAA、未分层结果的急诊与择期联合修复以及胸腹主动脉瘤的研究，以及未采用最新共识性AKI分类的研究。
共有6项研究纳入658例患者（前瞻性研究394例，回顾性研究264例），这些研究采用了最新的共识性分类（风险、损伤、衰竭、丧失、终末期肾病[RIFLE]、急性肾损伤网络分类[AKIN]、改善全球肾脏病预后组织[KDIGO]和动脉瘤肾损伤评分[ARISe]）并被纳入分析。肾下钳夹后，各研究间的AKI发生率相当，采用RIFLE分类时为24%，采用AKIN标准时为20%，采用ARISe分类时为26.3%。肾脏替代治疗（RRT）和30天死亡率的合并发生率分别为0.3%和1.4%。长期来看，无患者需要长期RRT。肾上钳夹后，2项回顾性研究采用RIFLE标准定义AKI发生率，合并AKI发生率为36.8%。在一项较小的回顾性研究中，采用KDIGO标准时AKI发生率为26.5%。RRT和30天死亡率分别为3.8%和2.9%。长期来看，1.2% - 3%的患者需要长期RRT。
AKI是AAA开放修复术后常见但通常为短暂性的并发症。其发生率取决于所使用的定义，且很少有研究采用最新的共识性AKI标准。未来，采用共识性AKI定义的大型前瞻性研究将有助于比较不同修复策略。
