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NDT Advance Access originally published online on February 3, 2007
Nephrology Dialysis Transplantation 2007 22(5):1361-1368; doi:10.1093/ndt/gfl779
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

High incidence of renal failure in patients with aortic aneurysms

Shinji Hagiwara1,2, Shigeki Saima1, Kousuke Negishi1, Ryo Takeda1, Naoko Miyauchi1, Yurika Akiyama1, Satoshi Horikoshi2 and Yasuhiko Tomino2

1Department of Nephrology, International Medical Center of Japan and 2Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan

Correspondence and offprint requests to: Prof. Yasuhiko Tomino, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan. Email: yasu{at}med.juntendo.ac.jp



   Abstract
Top
 Abstract
Introduction
 Materials and methods
 Results
 Discussion
 References
 
Background. Renal failure (RF) is a well-recognized complication of aortic aneurysms (AA) although its incidence has been poorly documented previously. The purpose of this study is to examine the incidence of RF in patients with AA and prognosis of AA patients with RF.

Methods. Renal function, complications and prognosis of AA patients with RF were retrospectively reviewed in 350 AA patients (median age 69.8 ± 10.7 years) in the International Medical Center of Japan from 1989 to 1999.

Results. Among 350 patients with AA, 90 patients (25.7%) had chronic renal failure (CRF) at the initiation of follow-up. The number of CRF patients increased to 117 (33.4%) at 30 months of follow-up. Forty-four out of 160 patients (27.5%) who had aortic surgery developed postoperative acute renal failure (ARF). Stepwise logistic regression analysis revealed that age (≥65 years), hypertension and multiple aneurysms were independent risk factors for CRF, whereas dissecting aneurysms, preoperative serum creatinine (sCr) levels and duration of surgery were independent risk factors for postoperative ARF in AA patients. In the 5-year follow-up of AA patients with CRF, the mean slopes of 1/serum-creatinine did not significantly differ between conservative treatment and surgical treatment. The survival rates were 49.5% in the conservative treatment group and 67.3% in the surgical treatment group.

Conclusion. Our data suggest that the management of renal function including blood pressure from an early stage in AA patients is important since CRF is highly prevalent in AA patients and affects their prognosis and mortality.

Keywords: acute renal failure; aortic aneurysm; chronic renal failure; prognosis; risk factors



   Introduction
Top
 Abstract
 Introduction
Materials and methods
 Results
 Discussion
 References
 
Recently, patients with aortic aneurysms (AA) have increased because of increases in the aged population and improvement of diagnostic techniques such as computerized tomography (CT) scans, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Accordingly, incidences of severe complications such as bleeding due to rupture of aneurysms or ischaemic organ failure are also increasing. Surgical repair of AA with or without cardiopulmonary bypass is associated with high mortality due to cardiac, pulmonary, spinal and renal complications [1,2]. Postoperative acute renal failure (ARF) in particular is a common complication of AA surgery and preoperative renal dysfunction is a major risk factor [2–13]. On the other hand, many AA patients who do not undergo surgery have chronic renal failure (CRF). Atherosclerosis and oppression of the renal artery or renal ischaemia due to arterial stenosis might be related to the incidence of CRF in AA patients. However, the incidence and risk factors of CRF in AA patients are poorly documented in the literature.

Therefore, we examined the incidence of CRF at the time of and 30 months after diagnosis of AA and ARF among AA patients who had surgery. We also compared the mean slopes of 1/serum-creatinine (1/sCr) and survival rate between conservative therapy and surgical therapy at 5 years of follow-up in AA patients with CRF.



   Materials and methods
Top
 Abstract
 Introduction
 Materials and methods
Results
 Discussion
 References
 
Patients
Three hundred and fifty AA patients admitted to International Medical Center of Japan from 1988 to 1999 were enrolled in the present study. The study population consisted of 250 men and 100 women (median age 69.8 ± 10.7, range 28–96 years).

Incidence of CRF in AA patients, detection and morphological findings of aneurysms
Detection of AA was classified into five types as follows: (i) patients’ complaints, (ii) emergencies such as rupture of AA or shock, (iii) coincidental detection with other diseases, (iv) routine medical examination and (v) unknown. The patients were not part of a screening programme searching for the presence of aortic aneurysms. Glomerular filtration rates (GFR) were calculated using the Modification of Diet in Renal Disease (MDRD) equation [14]. Calculated GFR of <60 ml/min continuously for >6 months was defined as CRF. The incidence of CRF in AA patients was analysed at the time of and 30 months after the diagnosis of AA.

The types of aneurysms were also classified morphologically as dissecting aneurysms (DA), non-dissecting aneurysms (NDA) and comorbidity of both types (DA + NDA). The association between incidence of CRF and type of aneurysm was examined.

Association between CRF and atherosclerotic disease or factors associated with atherosclerosis
Coronary artery disease (CAD) was defined as a clear history of angina pectoris, myocardial infarction and/or coronary stenosis (≥75%) evidenced by angiography. Hypertension was defined as systolic pressure of >140 mmHg and/or diastolic pressure of >90 mmHg. Hyperlipidaemia (HL) was defined as serum total cholesterol levels of >220 mg/dl and/or serum triglyceride levels of >150 mg/dl. The association between incidence of CRF and atherosclerotic disease or related factors was also examined.

Predictive factors associated with postoperative ARF in patients who had operations on aortic aneurysms
Postoperative ARF was defined as postoperative serum creatinine (sCr) levels increased by >1.5 times or postoperative GFR decreased by >25%. ARF was classified into three groups as follows: (i) mild ARF: postoperative sCr levels increased 1.5- to two-fold or postoperative GFR decreased by >25-50%, (ii) moderate ARF: postoperative sCr levels increased more than two- to three-fold or postoperative GFR decreased by >50-75% and (iii) severe ARF: postoperative sCr levels increased more than three-fold, postoperative sCr levels were >4 mg/dl (in cases of an acute increase of at least 0.5 mg/dl) or postoperative GFR decreased by >75% [15]. We examined the association among incidence of ARF, age, gender, morphology of the aneurysm, atherosclerotic disease, factors associated with atherosclerosis, preoperative renal function and intraoperative factors (surgery duration, amount of blood transfusion and intraoperative bleeding).

Progression of renal dysfunction and survival rate in AA patients with CRF treated surgically or conservatively
Thirty surgically treated AA patients with CRF and the same number of conservatively treated AA patients who had no operation or catheter intervention therapy with CRF were selected for the analysis. Surgical treatment was indicated by considering age, complications, size of the aneurysms and consent of patients or the families. In this study, conservatively treated patients were those who were clinically indicated for surgical treatment initially but did not consent to surgical treatment. The mean slopes of 1/sCr time curves and survival rate were compared between these two groups.

Statistical analyses
Data are expressed as mean ± SD. First, univariate analysis was performed using Student's t-test or Fisher's exact test. Variables with a P-value of <0.05 were then analysed using a stepwise logistic regression analysis on the basis of a forward–backward procedure. The F-value for entry or removal of candidate variables from the discriminant function was set at 4.0. Dummy variables were used for age (≥65 years = 1, <65 years = 0), gender (female = 1, male = 0), NDA (yes = 1, no = 0), DA (yes = 1, no = 0), multiple aneurysms (yes = 1, no = 0), hypertension (yes = 1, no = 0), cerebrovascular disease (yes = 1, no = 0), CRF (yes = 1, no = 0) and ARF (severe = 3, moderate = 2, mild = 1, no = 0). The survival rate was analysed using the Logran model. All calculations were performed using Stat View version 5.0. All P-values were two-tailed, and a P-value of <0.05 was considered significant.



   Results
Top
 Abstract
 Introduction
 Materials and methods
 Results
Discussion
 References
 
Incidence of CRF in AA patients, detection and morphological findings of aneurysms
Detection of 350 AA was as follows: patients’ complaints in 137 patients, coincidental detection in 130, medical examinations in 19 and emergencies such as shock or rupture of the aneurysm in 16 patients (Figure 1A). Morphological findings of the aneurysm were NDA in 226 patients, DA in 108, or both NDA and DA in 16 patients (Figure 1B). CRF was present in 90 patients (25.7%), and 17 patients (4.9%) were on haemodialysis at the initiation of follow-up. The incidence of CRF increased to 117 patients (33.4%) and haemodialysis patients increased to 32 (9.1%) after 30 months (Figure 2A). Age-related prevalence of CRF at 30 months after the diagnosis of AA is shown in Figure 2B. The prevalence of CRF in the age group under 64, 65–74 and >75 were 21.2, 35.8 and 39.3%, respectively. Yearly mean change of GFR in AA patients in the age group under 64, 65–70 and >75 were –3.57 ml/min, –3.62 ml/min and –3.32 ml/min, respectively (Table 1). As shown in Table 2, the incidence of CRF in DA patients and NDA patients was 24.1% (26 out of 108 patients) and 37.6% (85 out of 226 patients), respectively. Univariate analysis showed that NDA was significantly correlated with the incidence of CRF (P = 0.0251). Abdominal AA (AAA) tended to predict CRF although it was not statistically significant (P = 0.0642) in NDA. On the other hand, multiple aneurysms were significantly correlated with the incidence of CRF (P = 0.0005) in NDA. It should be noted that seven out of nine multiple aneurysm patients (77.8%) with CRF had AAA. Debakey's I tended to predict CRF compared with Debakey's II or III, although it was not statistically significant (P = 0.0917) in DA. There was no association between the incidence of CRF and size of the aneurysms (Table 2).


Figure 1
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  		Fig. 1. (A) Detections of aortic aneurysms. (B) Morphological findings of aneurysms in aortic aneurysm patients. DA, dissecting aneurysm; NDA, non-dissecting aneurysm.

 

Figure 2
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  		Fig. 2. (A) Incidence of chronic renal failure at the time of and 30 months after diagnosis of aortic aneurysms. (B) Age-related prevalence of chronic renal failure at 30 months after the diagnosis of aortic aneurysms.

 

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  		Table 1. Estimated GFR in baseline and mean change in GFR according to age

 

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  		Table 2. Association between chronic renal failure and the types, region, DeBakey's classification and size of aneurysms

 
Association between CRF and atherosclerotic disease or factors associated with atherosclerosis
CAD was present in 35.1%, whereas CRF was present in 33.4% of patients with AA (Figure 3A). Cerebrovascular disease (CVD) and arteriosclerosis obliterans (ASO) were present in 14 and 7.1%, respectively (Figure 3A). Smoking and hypertension were observed in 62.9 and 46.9% of AA patients, respectively. HL was observed in 25% and diabetes mellitus (DM) in 7.4% of these patients (Figure 3B). Univariate analysis showed age (≥65years), CVD and hypertension were significantly associated with the incidence of CRF (P = 0.0059, P = 0.0306 and P = 0.0035, respectively) (Table 3). However, there was no significant association of the incidence of CRF with CAD, ASO, DM, HL and smoking (Table 3).


Figure 3
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  		Fig. 3. (A) Incidence of chronic renal failure and other atherosclerotic complications in aortic aneurysm patients. CRF, chronic renal failure; ASO, arteriosclerosis obliterans; CVD, cerebrovascular disease; CAD, coronary artery disease. (B) Factors associated with arteriosclerosis in aortic aneurysm patients. HTN, hypertension; HL, hyperlipidemiaemia; DM, diabetes mellitus.

 

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  		Table 3. Association between chronic renal failure in aortic aneurysm arteriosclerotic complications, factors associated with arteriosclerosis or other factors

 
Predictive factors associated with postoperative ARF in patients who had operations on aortic aneurysms
A total of 160 AA patients, including six haemodialysis patients, underwent elective or emergency surgery. Among them, 44 patients (27.5%) developed ARF in which 17.5% was mild, 6.9% was moderate and 3.1% was severe (Figure 4). Fifteen patients (9.3%) received temporary haemodialysis or continuous haemodiafiltration for postoperative ARF. Ten patients finally developed end-stage renal disease (ESRD) and underwent maintenance haemodialysis. Six patients with postoperative ARF and nine patients without postoperative ARF including emergency operations were dead within one month after the operation. Postoperative ARF occurred in 15 out of 30 patients (50%) with DA and 28 out of 123 patients (23%) with NDA. Among the preoperative variables, univariate analysis showed that ARF was associated with DA (P = 0.0022), female gender (P = 0.0442) and preoperative sCr levels (P = 0.0233). Among the intraoperative variables, univariate analysis showed that ARF was associated with duration of the operation (P < 0.0001), the amount of bleeding (P = 0.0001) and blood transfusions (P = 0.0001) (Table 4).


Figure 4
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  		Fig. 4. Incidence of acute renal failure in aortic aneurysm patients who underwent aortic surgery. ARF, acute renal failure.

 

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  		Table 4. Preoperative and intraoperative factors associated with postoperative acute renal failure

 
Stepwise logistic regression analysis demonstrated that age (≥65 years), multiple aneurysms and hypertension were independent risk factors for CRF, whereas DA, preoperative sCr and duration of surgery were independent risk factors for postoperative ARF in AA patients (Table 5).


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  		Table 5. Stepwise logistic regression analysis of factors associated with CRF and ARF in AA patients

 
Progression of renal dysfunction and survival rate in AA patients with CRF treated surgically or conservatively
Surgically treated and conservatively treated groups were matched for age, sCr levels at the initiation of follow-up, morphological findings of the aneurysm, size of the aneurysm and atherosclerotic complications (Table 6). There was no significant difference in the mean slopes of 1/sCr (P = 0.233) (Figure 5). Among AA patients with CRF, the 5-year survival rate was 49.5% in the conservatively treated group and 67.3% in the surgically treated group. Although the surgically treated group had a higher survival rate, the difference was not statistically significant (P = 0.336) (Figure 6).


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  		Table 6. Clinical features of surgically treated and conservatively treated aortic aneurysms patients with chronic renal failure

 

Figure 5
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  		Fig. 5. Comparison of mean slopes of 1/sCr–time curves between surgically treated and conservatively treated aortic aneurysms patients with chronic renal failure.

 

Figure 6
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  		Fig. 6. Prognosis of surgically treated or conservatively treated aortic aneurysm patients with chronic renal failure.

 


   Discussion
Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
References
 
It is well known that postoperative ARF is a common complication of AA as reported previously (2–12). However, the incidence of CRF in AA patients and the prognosis of AA patients with CRF have not been fully examined. We showed incidence of CRF in AA patients had increased from 25.7 to 33.4% during 30 months of follow-up. Iseki et al. [16] reported the prevalence of GFR (estimated by the Gault–Cockroft formula) under 60 ml/min was >80% in Japanese patients (Okinawa) over 70 years of age. It is considered that this great prevalence of CRF with the elderly population of Okinawa in the article of Iseki et al. [16] may be due to the following: (i) Gault–Cockroft formula tends to underestimate renal function of the high-aged Japanese population, (ii) average life expectancy of the Okinawa population is the longest in Japan and (iii) there are regional variations in the incidence of ESRD in Japan and it is the highest in Okinawa [17]. There are no available data of calculated GFR using MDRD in the general Japanese population in relation to age to compare with our data at present time. Our data also suggest that high age is related to the incidence of CRF in AA patients. But the incidence of CRF was also high in the age group <65 years. It is suggested that there are more factors relating to the incidence of CRF other than high age in AA patients. Furthermore, yearly changes of GFR in AA patients were higher than in normal subjects (–1.03 ml/min/year), reported by Eriksen et al. [18]. These data indicated that AA patients have a risk of CRF and aggravated renal function. It may be important to identify the factors contributing to the incidence and progression of CRF in AA patients because preoperative CRF is a risk factor for mortality in surgical repair of such patients.

One possible cause of renal failure (RF) in AA patients is pre-renal factors such as low blood flow in the kidneys. Onitsuka et al. [13] reported that obstruction of renal blood flow occurred in about 7% of cases of acute dissection. They stated that reduced renal blood flow due to stenosis of the true lumen in DA, which was oppressed by the false lumen, was associated with RF and that massive bleeding due to rupture or myocardial infarction also causes RF [13]. Our data showed that NDA patients had a higher incidence of CRF than DA patients and AAA tended to predict CRF in NDA. Multiple aneurysms were shown to be an independent risk factor for CRF. Imaging information from these patients suggests that reduced renal blood flow due to renal artery stenosis, intraluminal thrombus or calcification of the aorta might affect the incidence of CRF in these patients. Enhanced CT scans, MRA and/or renoscintigraphy should be performed to estimate renal blood flow in patients with AA. There is a possibility that antiplatelet therapy may reduce the incidence of CRF in AA patients with intraluminal thrombosis of the aorta.

Glomerular sclerosis and glomerular hypertension may be common causes of the occurrence of CRF in AA patients since our data revealed that hypertension and age (≥65 years) were important related factors. Atherosclerotic diseases were not directly associated with CRF in AA patients in this study. On the other hand, AA appears to be correlated with atherosclerosis, aging, pulmonary emphysema, high blood pressure and angiotensin II [19]. Strict control of blood pressure is the principal therapy for inhibiting dilatation or rupture of AA and it also seems to be a key to prevent the incidence or development of CRF in AA patients.

As in our results, many authors reported that preoperative RF is an independent risk factor for postoperative ARF [2–12]. Patients with RF need sufficient hydration and/or dopamine infusion maintained during the operation [20]. In our hospital, long-term progression of renal dysfunction in AA patients with CRF did not significantly differ between surgical therapy and conservative therapy. This may be due to the improvement of pre- or postoperative management including continuous haemodiafiltration [21–23].

It appears that prevention of onset and progression to CRF in AA patients is important to indicate surgery and reduce the mortality since many authors reported that preoperative or postoperative RF increased postoperative mortality [11,12,20–22,24]. It seems that, in this study, CRF also increased the mortality in conservatively treated AA patients because the 5-year survival rate for conservative treatment was lower than that for surgical treatment (49.5% vs 67.3%) in AA patients with CRF. Hallett et al. [24] in the Mayo Clinic reported that the postoperative death rate in abdominal AA patients without complications was 3–5% and that of patients with complications such as CRF, chronic lung disease or liver cirrhosis was 8–10%. Chen et al. [12] reported that the surgical mortality rate was 3.8% in patients with non-ruptured abdominal AA. Independent predictors of death were preoperative myocardial infarction, prolonged postoperative ventilation, history of peripheral vascular disease, preoperative renal dysfunction and history of congestive heart failure (odds ratios: 5.0, 4.0, 2.9, 2.7 and 2.6, respectively) [12]. On the other hand, some authors reported a remarkable improvement of postoperative mortality in patients with RF due to improvement of diagnostic and operative techniques such as artificial grafts and pre- or postoperative management including continuous haemodiafiltration [20–23]. Aggressive treatment with careful management may be needed in AA patients with CRF because conservative treatment leaves a risk of rupture.

Nowadays, surgery is no longer the only invasive treatment for AA because of the possibility of stenting. As a result, it is possible that the incidence of RF may change in the future due to this new application. It is expected to reduce the postoperative mortality in patients with complications such as ischaemic organ failure because of its lower invasiveness. However, various complications have been reported as the number of cases increased, including growing haematoma, arterial thrombosis, iliac artery ruptures, thromboemboli, cholesterol emboli, graft thrombosis, graft migration and endoleak [24–25]. Walker et al. reported that in patients with preoperative RF, the perioperative death rate is high (27%) after endovascular AA repair [25]. Haddad et al. [27] reported that juxtarenal aneurysm repair with fenestrated endovascular graft following renal stenting was associated with a significant risk for adverse renal events (16% in patients without renal dysfunction and 39% in those with preoperative renal dysfunction; P = 0.04). Similarly, death was also more common in patients with preoperative renal dysfunction (17.4% vs 2%; P = 0.02). These reports suggest that further considerations for indications and improvement of catheter intervention therapy are necessary in AA patients with CRF.

In conclusion, CRF is highly prevalent in AA patients following CAD. Age, multiple aneurysms and hypertension were related factors for CRF in AA patients and preoperative CRF is a risk factor for postoperative ARF. It is necessary to pay attention to renal function in AA patients from the early stage since strict management of blood pressure inhibits the progression of CRF and decreases mortality in such patients.

Conflict of interest statement. None declared.



   References
Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 

  1. Utoh J, Kunitomo R, Hara M, et al. (1999) Clinical results of surgical repair for thoracic aortic aneurysms: intraoperative blood loss and morbidity. Kyobu Geka 52:717–723.[Medline]
  2. Godet G, Fleron MH, Vicaut E, et al. (1997) Risk factors for acute postoperative renal failure in thoracic or thoracoabdominal aortic surgery: a prospective study. Anesth Analg 85:1227–1232.[Abstract]
  3. Pronovost PJ, Dang D, Dorman T, et al. (2001) Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery. Eff Clin Pract 4:199–206.[Medline]
  4. Kashyap VS, Cambria RP, Davison JK, L’Italien GJ. (1997) Renal failure after thoracoabdominal aortic surgery. J Vasc Surg 26:949–957.[CrossRef][ISI][Medline]
  5. Safi HJ, Harlin SA, Miller CC, et al. (1996) Predictive factors for acute renal failure in thoracic and thoracoabdominal aortic aneurysm surgery. J Vasc Surg 24:338–344.[CrossRef][ISI][Medline]
  6. Barratt J, Parajasingam R, Sayers RD, Feehally J. (2000) Outcome of acute renal failure following surgical repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 20:163–168.[CrossRef][ISI][Medline]
  7. Carlson DE, Karp RB, Kouchoukos NT. (1983) Surgical treatment of aneurysms of the descending thoracic aorta: an analysis of 85 patients. Ann Thorac Surg 35:58–69.[Abstract]
  8. Schepens MA, Defauw JJ, Hamerlijnck RP, et al. (1994) Risk assessment of acute renal failure after thoracoabdominal aortic aneurysm surgery. Ann Surg 219:400–407.[ISI][Medline]
  9. Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. (1993) Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg 17:357–370.[CrossRef][ISI][Medline]
  10. Brewster DC, Cronenwett JL, Hallett JW Jr, et al. (2003) Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 37:1106–1117.[CrossRef][ISI][Medline]
  11. Johnston KW. (1989) Multicenter prospective study of nonruptured abdominal aortic aneurysm: Part II. Variables predicting morbidity and mortality. J Vasc Surg 19:437–447.
  12. Chen JC, Hildebrand HD, Salvian AJ, et al. (1996) Predictors of death in nonruptured and ruptured abdominal aortic aneurysms. J Vasc Surg 24:614–620.[CrossRef][ISI][Medline]
  13. Onitsuka T, Koga Y, Yonezawa T, et al. (1990) Renal function after aortic reconstruction for aortic dissection: special reference to the renal blood flow from false lumen. Kyobu Geka 43:856–863.[Medline]
  14. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461–470.[Abstract/Free Full Text]
  15. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. (2004) Acute Dialysis Quality Initiative workgroup. Acute renal failure: definition, outcome measures, animal models, fluid therapy and information technology needs. Crit Care 8:212.[CrossRef]
  16. Iseki K, Kinjo K, Iseki C, Takishita S. (2004) Relationship between predicted creatinine clearance and proteinuria and the risk of developing ESRD in Okinawa, Japan. Am J Kidney Dis 44:806–814.[CrossRef][ISI][Medline]
  17. Kato N, Usami T, Fukuda M, et al. (2005) Different regional dynamics of end-stage renal disease in Japan by different causes. Nephrology (Carlton) 10:400–404.[CrossRef][Medline]
  18. Eriksen BO and Ingebretsen OC. (2006) The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int 69:375–382.[CrossRef][ISI][Medline]
  19. Berk BC, Haendeler J, Sottile J. (2000) Angiotensin, II. Atherosclerosis, and aortic aneurysms. J Clin Invest 105:1525–1526.[ISI][Medline]
  20. Barkhordarian S and Dardik A. (2004) Preoperative assessment and management to prevent complications during high-risk vascular surgery. Crit Care Med 32:Suppl 4, S174–S185.[CrossRef][ISI][Medline]
  21. Sugawara Y, Sato O, Miyata T, et al. (1997) Surgical results of abdominal aortic aneurysm repair in patients with chronic renal dysfunction. Jpn Circ J 61:762–766.[CrossRef][Medline]
  22. Sugawara Y, Sato O, Miyata T, et al. (1998) Continuous hemodiafiltration during aortic arch aneurysm repair in chronic renal failure patient. Panminerva Med 40:63–65.[ISI][Medline]
  23. Yoshimura N, Asada T, Matsuda H, et al. (1991) Continuous hemofiltration vs hemodialysis for the acute renal failure after cardiovascular surgery. Nippon Kyobu Geka Gakkai Zasshi 39:1–6.[Medline]
  24. Hallett JW Jr. (2000) Management of abdominal aortic aneurysms. Mayo Clin Proc 75:395–399.[ISI][Medline]
  25. Walker SR, Yusuf SW, Wenham PW, et al. (1998) Renal complications following endovascular repair of abdominal aortic aneurysms. J Endovasc Surg 5:318–322.[CrossRef][ISI][Medline]
  26. Erbel R, Alfonso F, Boileau C, et al. (2001) Diagnosis and management of aortic dissection. Eur Heart J 22:1642–1681.[Free Full Text]
  27. Haddad F, Greenberg RK, Walker E, et al. (2005) Fenestrated endovascular grafting: the renal side of the story. J Vasc Surg 41:181–190.[CrossRef][ISI][Medline]
Received for publication: 11. 1.06
Accepted in revised form: 29.10.06


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