Renal Function and Abdominal Aortic Aneurysm (AAA) The Impact of Different Management Strategies on Long-Term Renal Function in the UK EndoVascular Aneurysm Repair (EVAR) Trials

Objective: To investigate the impact of different management policies on renal function in patients with abdominal aortic aneurysm. Summary Background Data: Limited longitudinal data exist on alterations in renal function in patients with abdominal aortic aneurysm. Escalating use of endovascular aneurysm repair (EVAR) with increased use of intensive imaging and contrast agents may have a deleterious effect on renal function. Methods: Multilevel modeling of estimated Glomerular Filtration Rate (eGFR), measured annually over an average of 3.6 years, was performed on 1194 patients enrolled in the randomized EVAR trials to compare renal function in patients managed with open or endovascular repair or no intervention and investigate, which factors were associated with fast renal decline. Results: For EVAR trial 1, the mean (SD) rate of change in eGFR was -1.13 (1.43) and -1.00 (1.43) mL/min/1.73 m(2) per year for the EVAR and open repair groups, respectively, but this difference was not statistically significant (P = 0.208). For EVAR trial 2, the mean (SD) rate of change in eGFR was -0.98 (1.49) and -0.76 (1.30) mL/min/1.73 m2 per year for the EVAR and no intervention groups, respectively (P = 0.087). Faster rates of renal function decline were significantly associated with larger aortic neck diameters (P = 0.003) and onset of graft-related complications after EVAR (P = 0.001). Conclusions: In these patients deterioration in renal function was slow, with little evidence to suggest any long-term difference between treatment with EVAR or open repair in fit patients or between EVAR and no intervention in unfit patients. Graft complications and larger neck diameters appear to be associated with faster renal function decline.