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Preoperative assessment of patients undergoing abdominal aortic surgery: chronic kidney disease is almost always present

Introduction

A number of preoperative patient-specific risk factors contribute to increased perioperative cardiovascular risk (myocardial infarction, heart failure, death) in patients undergoing major noncardiac surgery [1]. Renal impairment is one predictor. Creatinine values are a poor reflection of true renal function. Measures of the glomerular filtration rate provide a more accurate measure of renal function; as such, the true prevalence of renal impairment in this population may be significantly higher than previously appreciated. Our aim was to identify that proportion of elective vascular patients undergoing abdominal aortic surgery that have CKD, assessed by the estimated glomerular filtration rate (eGFR, ml/min/1.73 m2 body surface area; creatinine, μmol/l) [2].

Methods

A retrospective analysis of our 'ABC study' database was undertaken. The ABC study is an ongoing study looking at preoperative risk assessment using cardiopulmonary exercise testing in patients undergoing elective aortic surgery.

Results

Sixty-six patients were included in the analysis. All patients were Caucasians, 62 males (94%). No patient had a pre-existing diagnosis of chronic renal impairment. No patients had stage 4/5 CKD (severely reduced kidney function, eGFR < 30). Moderately reduced kidney function (eGFR 30–59, CKD stage 3) was seen in 20 (30%) patients, and mildly reduced kidney function (eGFR 60–89, CKD stage 2) in 44 (67%). Only two patients had normal kidney function. The mean total cholesterol for the cohort was 4.6 mmol/l (± 1 mmol/l). See Table 1.

Table 1 Table 1

Conclusion

The majority of vascular patients undergoing elective aortic surgery in our unit have impaired renal function that is not accurately reflected by creatinine values. Management of patients with stage 2 and 3 CKD is primarily cardiovascular risk assessment with aggressive treatment of modifiable vascular risk factors [3]. The full impact of risk factor modification on perioperative outcome in vascular patients requires further detailed investigation.

References

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    Eagle KA, Berger PB, Calkins H, et al.: ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery – executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1996 guidelines on perioperative cardiovascular evaluation for noncardiac surgery). Anesth Analg 2002, 94: 1052-1064. 10.1097/00000539-200205000-00002

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    K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification Am J Kidney Dis 2002, 39: S1-S266. 10.1053/ajkd.2002.32799

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    JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005,91(Suppl 5):v1-v52.

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Turley, A., Owen, S., Kothmann, E. et al. Preoperative assessment of patients undergoing abdominal aortic surgery: chronic kidney disease is almost always present. Crit Care 11, P393 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5553

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Keywords

  • Renal Impairment
  • Cardiopulmonary Exercise Testing
  • Normal Kidney Function
  • Risk Factor Modification
  • Cardiovascular Risk Assessment