Incidence and Transition of Acute Kidney Injury, Acute Kidney Disease to Chronic Kidney Disease after Acute Type A Aortic Dissection Surgery

Abstract

Acute kidney disease (AKD) is the persistence of renal injury between days 8 and 90 after an initial acute kidney injury (AKI). In this study, we aimed to explore the incidence of AKD, the association between AKD, and patient outcomes after acute type A aortic dissection (type A AAD) surgery. We identified 696 participants who underwent type A AAD surgery. Patients were categorized into stages 1 to 3 or 0 (non-AKD) AKD groups. Outcomes included major adverse kidney events (MAKEs), respiratory failure, all-cause readmission, and ischemic stroke from day 91 after operation. A total of 376 (54%) participants developed AKI, and 135/376 (35.9%) developed AKD. Moreover, 34/320 (10.6%) patients without AKI still developed AKD. Overall, 169/696 (24.3%) participants developed AKD. Patients with stages 2 and 3 AKD are associated with persisted declined renal function within 1 year. AKD was associated with a higher risk of MAKEs (hazard ratio (HR): 2.52, 95% confidence interval (CI) 1.90–3.33) and all-cause readmission (HR: 2.86, 95% CI: 2.10–3.89). Development of AKD with or without AKI is associated with a higher risk of MAKEs and hospitalization after acute aortic dissection surgery. Higher-stage AKD is associated with a trend of persistent decline in kidney function.

Admission Lysophosphatidic Acid Is Related to Impaired Kidney Function in Acute Aortic Dissection: 2-Year Retrospective Follow-Up Study

“…The incidence, trends, risk factors, management, and prognosis of AAD-related AKI have been revealed in a series of studies ( 6 , 20 ). Regardless of treatment strategy and definition of AKI, studies have shown that AAD-related AKI is associated with hypertension, diabetes, advanced age, gender, and arterial malperfusion, which is consistent with our findings ( 23 – 25 ). But non-linear correlations, subgroup analyses, and interactions have not been well characterized in other studies and are the focus of this investigation.…”

“…Although the pathogenesis of CKD is complex, evidences show that exogenous glycerol-3-phosphate (G-3-P) stimulated bone and bone marrow fibroblast growth factor-23 (FGF-23) production through local G-3-P acyltransferase mediated (GPAT-mediated) LPA synthesis ( 11 , 32 ). FGF-23 levels increasing may contribute directly to the transition of AKI to chronicity, through profibrotic effects and effects on renal immune function damage, and LPA plays an important role throughout the process by activating LPA receptor 1 ( 11 , 25 , 33 , 34 ). There is also evidence that blockade of the LPA1/3 receptor activity attenuated glomerular injury by reducing podocyte loss, prevented a decline in glomerular filtration rate (GFR) and reduced proteinuria ( 35 , 36 ).…”

Acute renal failure after acute type A aortic dissection repair. Insidious postoperative complication with poor short‐ and long‐term prognosis

“…Postoperative ARF creates a risk factor for immediate and late renal replacement therapy (RRT) which will affect the overall survival of patients who are treated for ATAAD repair. 11, [15][16][17][18][19] Brown et al presented the effect of ARF on the long-term survival of patients who were operated on for ATAAD under hypothermic circulatory arrest (HCA). 1 The observational study were at risk for the development of postoperative ARF.…”

“…Recently, many studies have included postoperative ARF as the end-point for primary outcomes of patients with ATTAD. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] From May 2020 to October 2021 over 10 studies have been published with this end-point. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The incidence of postoperative ARF was 10.5%-68.1%.…”

“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] From May 2020 to October 2021 over 10 studies have been published with this end-point. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The incidence of postoperative ARF was 10.5%-68.1%. 15,18,20,[22][23][24][25][26][28][29][30] The most common predisposing factors for postoperative ARF were preoperative renal dysfunction, RBC transfusion unit, preoperative malperfusion syndrome, and duration of CPB time.…”