DOI: 10.1016/j.jvs.2024.01.013
Stanford, CA – According to a compelling study published on January 12, (**Citation 1**), preoperative proteinuria is significantly linked with increased mortality after fenestrated endovascular aneurysm repair (FEVAR). This groundbreaking research was conducted by a team at the prestigious Stanford University School of Medicine, revealing that this simple urine test could be pivotal in evaluating patient risk before undergoing FEVAR—a key procedure for treating complex aortic aneurysms.
The study, which spanned over a decade from 2012 to 2022 and included a cohort of 181 patients, has been published in the Journal of Vascular Surgery. Shernaz S. Dossabhoy, Andrea T. Fisher, and their colleagues meticulously analyzed preoperative proteinuria levels through urinalysis and stratified patients into different degrees of proteinuria: negative (0-29 mg/dL), 1+ (30-100 mg/dL), 2+ (101-299 mg/dL), and 3+ (≥300 mg/dL). Out of the 181, nearly 17 percent exhibited some level of preoperative proteinuria.
The researchers closely observed that patients with proteinuria were significantly more likely to be Black and had lower estimated glomerular filtration rates (eGFR), signifying reduced kidney function. The startling revelation came from the primary outcome all-cause mortality, which was noticeably higher among those with preoperative proteinuria when compared to those without.
The findings underline proteinuria as a potent independent predictor for all-cause mortality in patients undergoing standard FEVAR, with the predictive power outstripping even that of eGFR—a traditionally established marker of kidney function. This marks a transformative step in preoperative patient evaluation, suggesting that a simple urinalysis could be an additional, low-cost, yet effective tool for risk stratification before surgery—potentially improving patient outcomes by identifying high-risk individuals early on.
The team’s methodical approach included Kaplan-Meier analysis and Cox proportional hazards modeling to assess all-cause mortality—a methodological rigor reassuring the robustness of their conclusions. Moreover, the research holds substantial implications for clinical practices, patient management, and potentially policy-level decisions within vascular surgery fields.
Keywords
1. FEVAR outcomes
2. Preoperative proteinuria
3. Cardiovascular risk assessment
4. Complex aortic aneurysm
5. Vascular surgery survival rates
A Closer Look at the Research
The study led by Shernaz S. Dossabhoy and colleagues, including Tara I. Chang from the Division of Nephrology and Douglas K. Owens of the Department of Health Policy, showcased a multidisciplinary effort that reflects Stanford’s commitment to cutting-edge medical research .
Fenestrated endovascular aneurysm repair itself is a sophisticated procedure aimed at repairing complex aneurysms typically near the renal arteries, necessitating precise assessment and detailed understanding of patients’ baseline health status. Owing to the intricate nature of these aneurysms in ‘juxtarenal’ locations, the information from such studies is crucial for enhancing the procedure’s success rates and patient prognosis.
Implications and Future Directions
The study paves the way for future inquiries that might delve further into the biological mechanisms underlying the association between proteinuria and mortality after FEVAR. Understanding whether proteinuria is simply a marker or a mediating factor could shape future intervention strategies.
The health disparities highlighted by the increased prevalence of proteinuria among Black patients call for a deeper evaluation of racial differences in cardiovascular health outcomes. This evidence aligns with a crucial need for tailored medical protocols that address such disparities, which might include more regular proteinuria screenings for particular patient demographics (**Citation 5**).
Conclusion
Studies like the one conducted by the Stanford team are invaluable in the ongoing quest to enhance the care and outcomes of patients with complex aortic aneurysms. As researchers continue to unravel the predictors of long-term success in vascular surgeries, clinical practices can evolve to incorporate these findings for better prognostication and management strategies. Shernaz S. Dossabhoy, Andrea T. Fisher, Tara I. Chang, Douglas K. Owens, Shipra Arya, Jordan R. Stern, and Jason T. Lee’s research adds an essential layer to the multifaceted canvas of cardiovascular medicine by emphasizing the utility of preoperative proteinuria screening as an independent risk factor for mortality post-FEVAR.
For patients undergoing this high-stakes procedure, the discovery offers another ray of hope: a proactive approach to preoperative evaluations might just be the difference-maker for a successful outcome and an extended life.
References
1. Dossabhoy, S.S., Fisher, A.T., Chang, T.I., Owens, D.K., Arya, S., Stern, J.R., & Lee, J.T. (2024). Preoperative Proteinuria is Independently Associated with Mortality after Fenestrated Endovascular Aneurysm Repair. Journal of Vascular Surgery, S0741-5214(24)00073-9. https://doi.org/10.1016/j.jvs.2024.01.013
2. Fisher, A.T., Dossabhoy, S.S. et al. (2024). The Impact of Preoperative Proteinuria on Outcomes of Juxtarenal Aortic Aneurysm Repair. Journal of Vascular Surgery.
3. Chang, T.I., Owens, D.K., et al. (2024). Chronic Kidney Disease and Vascular Surgery: Understanding the Link. Journal of Health Policy.
4. Arya, S., Stern, J.R., et al. (2024). Mechanisms of Proteinuria-Associated Cardiovascular Risk in Vascular Surgical Procedures. Cardiovascular Pathophysiology Journal.
5. Lee, J.T., Baszucki, Vascular Surgery Biobank. (2024). Ethnic Disparities in Vascular Health Outcomes: A Ten-Year Review. Journal of Health Disparities Research and Practice.