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A Systematic Review and Meta-analysis of Renal Dysfunction following Endovascular Aneurysm Repair (EVR) #MMPMID25140912
Karthikesalingam A; Bahia SS; Patel SR; Azhar B; Jackson D; Cresswell L; Hinchliffe RJ; Holt PJ; Thompson MM
Kidney Int 2015[Feb]; 87 (2): 442-51 PMID25140912show ga
Deterioration in renal function has been described after endovascular repair of abdominal aortic aneurysms (EVR). The aetiology is multifactorial and represents an important therapeutic target. A need exists to quantitatively summarise incidence and severity of renal dysfunction after EVR to allow better-informed attempts to preserve renal function and improve life expectancy. A systematic search was performed using Medline and Embase for renal function after EVR applying PRISMA statements. Univariate and multivariate random effects meta-analyses were performed to estimate pooled post-operative changes in serum creatinine and creatinine clearance at four time points after EVR: 0-7 days, 30 days/1 month, 1 month-1year and ?1year. Clinically relevant deterioration in renal function was also estimated at ?1year after EVR. 23 papers were identified for analysis. Pooled probability of clinically-relevant deterioration in renal function ?1year was 18% (95% CI=14-23%,I²=82.5%). From univariate meta-analyses, serum creatinine increased after EVR by of 0.05mg/dL at 30 days/1month, 0.09mg/dL at 1 month to 1 year and 0.11mg/dL at ? 1 year (all p<0.05). Creatinine clearance reduced after EVR by 5.65 ml/min at 1 month-1 year and 6.58 ml/min at ?1 year (both p<0.05). Renal failure after EVR is underreported and reporting standards are poorly followed. Clinically relevant deterioration in renal function is common and merits focussed attention to attenuate impact on long-term mortality.