Acute kidney injury and aorta-related mortality during open surgery of the abdominal aorta with suprarenal clamping using different renal protection strategies

Objective: The aim was to evaluate the incidence of acute kidney injury in patients treated with open surgical repair and suprarenal cross-clamp comparing no-perfusion strategy vs. the renal perfusion with the histidine-tryptophan-ketoglutarate solution. Methods: It is a physician-initiated, multicenter, retrospective observational study including patients treated with open surgical repair for abdominal aortic aneurysm between January 1st, 2015, and December 31st, 2021. Patients already on dialysis were excluded from the final analysis. A coarsened exact match identified two cohorts: no-perfusion strategy vs. renal perfusion with the histidine-tryptophan-ketoglutarate solution. Primary outcomes were acute kidney injury incidence and survival at 30-day. Secondary outcomes were freedom from hemodialysis and survival at 1 year. Results: We analyzed 125 (28.7%) patients: 63 (14.5%) who did not receive renal perfusion and 62 (14.2%) who received the histidine-tryptophan-ketoglutarate perfusion. At 30-day, acute kidney injury rate (37.6%) was not different between the two groups [n = 24 (38.7%) vs. 23 (36.5%); OR: 1.1, P = 0.855]. At 30-day, acute kidney injury development was associated with aneurysm extent (pararenal, OR: 2.28, 95%CI: 1.031-5.031, P = 0.042), and total time of intervention (threshold: 365 minutes, OR: 1.008, 95%CI: 1.003-1.012, P = 0.001). At 1-year, postoperative acute kidney injury did not impact mortality (OR: 3.4, P = 0.556), and freedom from hemodialysis was 100%. Conclusion: Postoperative acute kidney injury remains high at nearly 38% but it did not impact on freedom from hemodialysis at 1-year as well as on overall survival.