<p><b>BACKGROUND</b>
Acute kidney injury (AKI) is considered as a common and significant complication following
abdominal aortic aneurysm (AAA) repair. This study aimed to assess the associated
risk factors of AKI in the
critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific
population .</p><p><b>
METHODS </b>We retrospectively examined data from all
critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable
analysis was used to identify factors associated with postoperative AKI, which was defined by
risk ,
injury , failure, loss and end-stage (RIFLE)
kidney disease criteria. The
goal -directed
hemodynamic optimization (
maintenance of optimal
hemodynamics and neutral or negative
fluid balance ) and renal outcomes were also reviewed.</p><p><b>RESULTS</b>Of the 71
patients enrolled, 32 (45.1%) developed AKI, with 30 (93.8%) cases diagnosed on admission to
surgical intensive care unit (SICU).
Risk factors for AKI were ruptured AAA (
odds ratio (OR) = 5.846, 95%
confidence interval (CI) 1.346 - 25.390), intraoperative
hypotension (OR = 6.008, 95%CI 1.176 to 30.683), and perioperative
blood transfusion (OR = 4.611, 95%CI 1.307 - 16.276).
Goal -directed
hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall
in-hospital mortality was 2.8%. AKI was associated with significantly increased
length of stay ((136.9 ± 24.5) hours vs. (70.4 ± 11.3) hours) in
Surgical Intensive Care Unit.</p><p><b>CONCLUSIONS</b>
Critically ill patients undergoing AAA repair have a high
incidence of AKI, which can be early recognized by RIFLE criteria.
Rupture ,
hypotension , and
blood transfusion are the significant associated
risk factors . Application of
goal -directed
hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.</p>