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September 4, 2019

Study Demonstrates Impact of EVAR on Long-Term Renal Function

September 5, 2019—Findings from a study that aimed to define long-term renal decline after elective endovascular aneurysm repair (EVAR) using estimated glomerular filtration rate (eGFR) were published by Edmund R. Charles, BMBS, BMedSci, et al in European Journal of Vascular and Endovascular Surgery (EJVES; 2019;58:328–333).

According to the investigators, the background of the study is that although EVAR is associated with superior outcomes compared with open repair over the short term, the progression of renal function after EVAR remains unknown because of the use of inconsistent reporting measures.

As summarized in EJVES, investigators used the prospectively maintained in-house database to identify consecutive patients having elective EVAR who had been followed up for > 5 years.

The study was composed of 275 patients (23 females, 8%; mean age, 75 years) who were not previously on renal replacement therapy (RRT) and were treated from January 2000 to July 2010. Preoperative, postoperative, and most recent eGFR values were evaluated using the chronic kidney disease epidemiology collaboration equation.

The primary outcome was change in eGFR at latest follow-up. Patients were followed-up over a median of 9 years (range 5–17 years).

The investigators reported that patients’ mean eGFR dropped from a preoperative value of 67 mL/min/1.73 m2 (standard deviation [SD], 9.4) to 52 mL/min/1.73 2 (SD, 7.7), which amounts to a yearly loss of 1.7 units. Six patients (2%) required RRT (dialysis) during late follow-up.

Patients requiring RRT and those with an eGFR loss > 20% at latest follow-up compared with baseline were more likely to die during late follow-up (odds ratio, 2.4 and 3.3, respectively; P < .001).

According to the investigators, this analysis provides some of the longest available follow-up to date. They concluded that the data suggest that patients undergoing EVAR may experience a significant long-term decrease in renal function. This needs to be taken into account when offering EVAR in younger patients; renal follow-up and preservation should be optimized in this patient group, advised the investigators in EJVES.

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