Influence of Perioperative Three-Dimensional CT Angiography and Surgical Clipping for Unruptured Cerebral Aneurysms on Renal Function in Patients with Chronic Kidney Disease.

BACKGROUND: Surgical clipping is a valuable treatment option for unruptured intracranial aneurysms in patients with chronic kidney disease (CKD). However, the comprehensive impact of clipping and perioperative three-dimensional computed tomography angiography (3D-CTA) on renal function remains unclear. This study aimed to evaluate the effects of perioperative 3D-CTA and surgical clipping on renal function in patients with CKD.

METHODS: We retrospectively analyzed 529 patients who underwent surgical clipping and perioperative 3D-CTA. An estimated glomerular filtration rate (eGFR) < 60 was defined as CKD. Patients were stratified according to their renal function (group 1: eGFR ≥ 60, group 2: 45 ≤ eGFR < 60, group 3: 30 ≤ eGFR < 45, group 4: eGFR < 30 ml/min/1.73 m2 ), and eGFR was assessed preoperatively and 1 week and several months postoperatively.

RESULTS: Of the 529 patients, 442 did not have CKD and 87 had CKD. Hypertension, hyperlipidemia and hyperuricemia were significantly more common in those with CKD. After the surgery and perioperative series of 3D-CTA, renal function deterioration was not observed in any group, whether in the acute or chronic postoperative period. Notably, eGFR significantly increased in groups 2 (66.7 ± 10.1, p<0.01) and 3 (48.9 ± 9.2, p=0.02) 1 week postoperatively, despite the CKD.

CONCLUSIONS: Surgical clipping of unruptured intracranial aneurysms and perioperative 3D-CTA with normal-dose contrast media did not impair renal function in patients with CKD. These results could be valuable in determining treatment strategies for those with CKD and intracranial aneurysms.