Outcome in patients requiring renal replacement therapy after surgery for ruptured and non-ruptured aneurysm of the abdominal aorta

Objectives: to study the course of postoperative acute renal failure requiring renal replacement therapy (RXT) in patients with ruptured (RAAA) and non-ruptured (EAAA) aneurysm of the abdominal aorta (AAA) and to investigate the predictive value regarding outcome of parameters collected during the illness. Design: retrospective study in a university hospital. Materials and methods: the records of 42 patients, 21 with RAAA and 21 with EAAA, were reviewed. Results: overall mortality was 69%, 72% for RAAA patients and 66% for EAAA patients. RRT was started 9 (2-28) days - median (range) - postoperatively and continued during 9 (2-50) clays. Renal function recovered in nine of the 13 survivors after 18 (2-50) days. Length of ICU stay was 50 (2-132) days for survivors vs. 19 (6-56) days for nonsurvivors. The systemic inflammatory response syndrome (SIRS) or need for vasoactive support was associated with poor outcome and the ability to wean from vasoactive or ventilatory support with improved outcome. Conclusions: RAAA and EAAA patients requiring postoperative RRT both had a high mortality. The ICU stay of non survivors was shorter than that of survivors, who had a 75% chance of regaining renal function. The ability to wean from ventilatory and inotropic support may be of help in the clinical management of patients requiring RRT after AAA surgery.