Peri-operative risk factors of chronic kidney disease after Acute Repair of Type A Aortic Dissection surgery

Abstract Objective Cardiac surgery associated-acute kidney injury (CS-AKI) occurs in 40–55% of patients undergoing surgery for repair of acute type A aortic dissection (ATAAD). Few studies have investigated the association of postoperative AKI with kidney dysfunction seen long-term in patients after surgical repair for ATAAD. The aim of our study was to identify the risk factors of developing post-ATAAD repair chronic kidney disease (CKD) at 6 months. Methods We retrospectively reviewed a contemporary cohort of all patients who underwent surgery for ATAAD repair from January 1, 2020 to December 31, 2021 at Xiamen Cardiovascular Hospital affiliated with Xiamen University. Results Of the 255 included patients, frequency of ATAAD AKI was 112/255 (56.1%). Renal malperfusion (OR 2.175, p = 0.00591), intraoperative urine output (OR 0.75/ 1 ml/kg/h, p < 0.001) and intraoperative RBC transfusion (OR 1.27(/ 1 U, p = 0.00613) were significantly associated with early post ATAAD repair AKI. AKI was independently associated with postoperative adverse composite outcome(OR 3.496, 95% CI 1.955 ~ 6.379). CKD data was non-missing for 87% of participants, among the 232 patients included, 40 of 232 (17.2%) had post-operative CKD. The independent predictors of CKD at 6 mouths were body mass index (OR = 0.827, 95% CI: 0.723 ~ 0.931), cardiac tamponade (OR = 5.344, 95% CI:1.65 ~ 17.958), eGFR baseline < 60mL/min/BSA (OR = 12.629, 95% CI:5.003 ~ 35.373), time to peak SCr > 3 days after surgical repair (OR = 7.566, 95% CI: 2.799 ~ 22.731), and a graded effect of AKI [stage 1 (OR = 4.418, 95% CI: 1.339 ~ 15.361), stage 2 (OR = 8.345, 95% CI: 1.762 ~ 40.499) and stage 3 (OR = 9.463, 95% CI: 2.602 ~ 37.693)]. Conclusions The peri-operative period has a major impact on CKD incidence. Both duration and severity of AKI provide prognostic value to predict the development of CKD.