Diseases of the Aorta and Kidney Disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Figures

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  Figure 1. Incidence rate of AAA hospitalizations per 1,000 for CKD measures (A: eGFR, B: ACR), adjusted for age, gender, race, and centre in the Atherosclerosis Risk in Community Study. The demographically adjusted hazard ratio (HR) for AAA development was 4.44 (95% CI 1.58–12.49) for eGFR <30 mL/min/1.73 m2, 3.29 (1.89–5.72) for 30–44 mL/min/1.73 m2, 2.03 (1.29–3.19) for 45–59 mL/min/1.73 m2, and 1.62 (1.11–2.35) for 60–74 mL/min/1.73 m2 compared with eGFR ≥90 mL/min/1.73 m2. Furthermore, the demographically adjusted HR was 2.49 (1.28–4.87) for ACR ≥300 mg/g, 1.99 (1.40–2.83) for 30–299 mg/g, and 1.46 (1.08–1.97) for 10–29 mg/g compared with ACR <10 mg/g. These associations were generally similar after accounting for additional covariates or after stratifying by subgroups. Adapted with permission from Matsushita et al.9

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  Figure 2. The effect of pre-existing CKD on survival on 47 715 patients undergoing surgery for AAA (25.7% open repairs and 74.3% EVAR). Blue line: subjects with eGFR > 60 mL/min/1.73 m2 (no CKD, or CKD G1 and G2). Red line, left figure: patients with moderate CKD (G3), right figure: patients with severe CKD (G4 and G5). Adapted with permission from Aranson et al.11

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  Figure 3. Established and potential CKD-specific risk factors and pathophysiologic mechanisms for AAA development.

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  Figure 4. Classification of abdominal aortic aneurysms. Infrarenal aneurysms have a proximal aortic neck that provides an adequate landing zone for the endovascular device; in juxtarenal aneurysms the aneurysm involves the infrarenal abdominal aorta adjacent to or including the lower margin of renal artery origins; suprarenal AAAs and thoraco-abdominal aneurysms extend above the orifice of renal arteries.

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  Figure 5. Kaplan–Meier curves indicating cumulative freedom from the combined cardiovascular end-point for patients with or without AKI after EVAR (left figure) or open repair (right figure) for AAA. From Saratzis A et al.,63 with permission.

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  Figure 6. The types of endoleaks after endovascular aortic repair: Type I, leak at the proximal or distal landing of the graft; Type II, leak via branches (e.g. lumbar artery) into the aneurysm sac; Type III, modular defect or tearing of the graft material; Type IV, graft porosity.

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  Figure 7. Long-term kidney function after AAA repair according to treatment type. OAR, patients with open repair; EVAR (infra), patients infrarenal EVAR; EVAR (supra), patients with suprarenal EVAR; CEA patients with carotid endarterectomy, without AAA serving as the control group. From Saratzis et al.,12 with permission.