Risk factors for acute kidney injury after initial acute aortic dissection and their effect on long-term mortality

Abstract

Background: Several reports have discussed the risk factors for acute kidney injury (AKI) after thoracic aortic surgery and aortic dissection and the increased mortality in patients with AKI. However, there are few reports on the risk factors for AKI with combined medical and surgical treatment and the influence on mortality. The aim of this study was to clarify the risk factors and long-term effects of AKI on mortality and kidney function after acute aortic dissection in a cohort at our hospital. Methods: We retrospectively investigated 96 patients with initial acute aortic dissection between April 2012 and January 2015. We divided the subjects into two groups: 65 with AKI and 31 without AKI using RIFLE criteria. The outcomes were all-cause mortality and the decrease in kidney function after 6 and 12 months. We extracted the risk factors for AKI by multivariate logistic regression using clinical parameters. Results: A history of hypertension, type A aortic dissection, and low platelet levels were statistically significant factors to predict AKI after aortic dissection (odds ratio [OR] 9.1, 95 % confidence interval [CI] 1.42-58.5, p = 0.02; OR 25.2, 95 % CI 3.1-205.0, p = 0.003; OR 0.82, 95 % CI 0.68-0.98, p = 0.033, respectively). Three patients with AKI died and 1 patient recovered from AKI. The kidney function in survivors was similar in those with and without AKI. Although there were no significant differences in long-term kidney function between groups, long-term mortality was worse in the AKI group (p = 0.017). Conclusions: Hypertension, type A aortic dissection, and low platelet levels were risk factors for AKI after aortic dissection, and AKI increased the 1-year all-cause mortality. A large-scale study is needed to verify our results.

Impact of renal dysfunction on surgical outcomes in patients with aortic dissection

“…A retrospective study by Kato et al showed that TAAD is a risk factors for AKI after aortic dissection, and AKI increased the all-cause mortality. [7] Another study by Pisimisis et al showed that thoracic aortic endograft has a significant rate of renal dysfunction. [8] Some literatures revealed renal ischemia as risk factor of surgical outcome of acute TAAD.…”

Retrograde Inferior Vena Caval Perfusion for Total Aortic Arch Replacement Surgery (RIVP-TARS): A Multicenter, Randomized, Controlled, Double-Blind Trial

“…Briefly, the circuit consists of a membrane oxygenator, a heat exchanger, and two rolling pumps, which can bifurcate the arterial line for both artery perfusion and inferior vena caval perfusion as necessary. For patients in the RIVP group, moderate hypothermia (defined as a nasopharyngeal temperature of [26][27][28] °C and rectal temperature of 28-30 °C) will be induced under CPB, then systemic perfusion will be stopped and the aorta opened. ACP and RIVP will then be performed using the two rolling pumps.…”

“…2008;23(5): 480-7. ] The current preferred strategy for AAAD surgery is ACP+MHCA at [25][26][27][28][29][30], [endnoteRef:19]. ACP is performed by the perfusion of oxygenated blood via the subclavian artery, innominate artery, or the right axillary artery during hypothermic circulatory arrest (HCA) Since lower-body circulatory arrest is needed during ACP, organs in the lower body such as the viscera and spinal cord are still at risk of ischemia.…”

Retrograde Inferior Vena caval Perfusion for Total Aortic arch Replacement Surgery (RIVP-TARS): study protocol for a multicenter, randomized controlled trial

“…Nevertheless, ACP + MHCA is associated with overall 30-day mortality rates of 5.3–19% [22, 23] and stroke rates of 6.7–10% [24, 25]. The incidence of acute kidney injury in ACP + MHCA ranges from 19 to 54%, [26, 27] with 5–9% of these patients requiring renal replacement therapy, which is itself associated with an elevated short-term mortality rate of 30–75% [26, 28].…”