Mild Renal Insufficiency May Complicate CAE

Jeff Evans

WASHINGTON -- Renal insufficiency in patients undergoing carotid endarterectomy is associated with an increased likelihood of postoperative death in severe cases and cardiac or pulmonary complications in cases with milder kidney dysfunction, Dr. Gilbert Aidinian reported at the annual meeting of the Eastern Vascular Society.

Most studies focused on the outcomes of renal-insufficient patients after carotid endarterectomy (CEA) have found that individuals who are already on hemodialysis have an increased risk of morbidity and mortality following the operation. But in predialysis renal-insufficient patients, it has not been determined if an increased risk of complications after CEA is confined to those with end-stage renal disease or if it extends to patients with milder insufficiency, said Dr. Aidinian of the Washington DC VA Medical Center.

He and his colleagues used data compiled in the National Surgical Quality Improvement Program on patients who received CEA at 123 Veterans Affairs hospitals during 1995-2003. In a set of 20,899 patients who had undergone CEA but were not receiving dialysis at the time, the investigators found in a multivariate analysis that 511 patients with a calculated glomerular filtration rate (GFR) of less than 30 mL/min per 1.73 m2 were 2.7 times more likely to die within 30 days of the operation than were the 13,965 patients who had a calculated GFR of 60 or greater.

In multivariate analyses, patients with a calculated GFR of 30-59 were 60% more likely to develop cardiac complications and 30% more likely to develop a pulmonary adverse event.