SP235STROKE VOLUME VARIATION: "A REAL TIME " BIOMARKER OF ACUTE KIDNEY INJURY DURING ABDOMINAL AORTIC ANEURYSM SURGERY

Abstract

INTRODUCTION AND AIMS: Patients undergoing abdominal aortic aneurysm (AAA) surgery with suprarenal clamping are at high risk for acute kidney injury (AKI). In these patients, hemodynamic instability and ischemic damage play a key role in the development of AKI. Stroke volume variation (SVV) is a dynamic measure of fluid responsiveness and hemodynamic instability in mechanically ventilated patients. We aimed to assess whether increased SVV is associated with AKI in patient undergoing elective AAA surgery with suprarenal clamping. METHODS: Design. Prospective observational study. Materials. An EV1000 Clinical Platform (Edwards Lifesciences, Irvine, CA, USA) with the FloTrac system 4.0 was used to measure mean blood pressure and calculate the SVV. Methods. During the procedure, fluids were prescribed after consideration of standard parameters. AKI was defined according with the KDIGO clinical practice guideline for AKI criteria. RESULTS: Of the 30 patients consecutively enrolled, fourteen (47%) developed AKI. In a multivariate linear regression analysis adjusted for age, gender and baseline SVV, the increase of SVV 2h after the end of surgery (beta 0.08 mg/dl, 95%CI 0.04-0.12 mg/ dl, P<0.001) and clamp time (10 min: beta 0.21 mg/dl, 95%CI 0.05-0.37 mg/dl, P=0.01) predict independently the rise of serum creatinine 24h after the end of surgery. In multivariate mixed models, SVV increased progressively from baseline to the first 12h of follow-up only in subjects who will develop AKI (beta 4.7%; 95%CI 1.1-8.4%; P=0.01). CONCLUSIONS: In patients undergoing AAA surgery with suprarenal clamping, the rise of SVV during and after surgery and the clamping time predict the onset of AKI. (Figure Presented).