Outcomes and acute kidney injury following open aortic surgery with suprarenal clamping

BACKGROUND: The aim of this study was to evaluate postoperative renal function after open surgery with suprarenal clamping using different strategies of renal protection, considering the lack of precise recommendations in the recent Italian (SICVE, 2021) and European (ESVS, 2019) Guidelines.METHODS: Primary endpoints were postoperative renal function and related mortality; secondary endpoints: postoperative complications and efficacy of renal perfusion (crystalloids/histidine-tryptophan-ketoglutarate, HTK). Acute renal injury (AKI) classification followed KDIGO guidelines.RESULTS: The retrospective analysis included 60 patients (2018-2021). Incidence of AKI was 50%. Severe AKI (KDIGO 2/3) rate was 20%. These patients had significantly higher rates of postoperative complications, reoperations, and on average longer hospital stays (P<0.001). Patients with chronic kidney failure (CKD) were more likely to develop postoperative AKI (P=0.016). CKD patients had a significantly lower incidence of AKI (P=0.031) with HTK perfusion. Overall mortality was 18.3%, 23.5% in CKD patients and 23% among patients with postoperative AKI. Remarkably, 85% of deaths at 30 days were recorded among patients with AKI, resulting significantly higher than deaths from other causes (P=0.035).CONCLUSIONS: Prevention of AKI is essential to reduce postoperative complications, reoperations, and mortality. Patients with preoperative normal renal function do not appear to benefit from a particular renal protection strategy, while patients with preexisting CKD, show a relevant rate of AKI following suprarenal clamping: in this subgroup HTK solution seems to have a role in the prevention of AKI and therefore of a more complex course.