Perioperative risk factors for chronic kidney disease after acute type A aortic dissection repair: A retrospective cohort study
- VernacularTitle:急性A型主动脉夹层修复术后远期肾功能不全围手术期危险因素的回顾性队列研究
- Author:
Pianpian YAN
1
;
Xijie WU
2
;
Shengwen GUO
1
;
Yiting HUANG
1
;
Meili LU
1
;
Lulu JIANG
1
;
Yanqing ZHOU
1
;
Jiarong MA
1
Author Information
1. Department of Anaesthesia, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361002, Fujian, P. R. China
2. Department of Cardiovascular Surgery, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361002, Fujian, P. R. China
- Publication Type:Journal Article
- Keywords:
Acute kidney injury;
acute type A aortic dissection;
chronic kidney disease;
renal recovery;
renal hypoperfusion syndrome
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2025;32(11):1588-1596
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the renal function recovery and perioperative risk factors for chronic kidney disease in patients after acute Stanford type A aortic dissection (ATAAD) repair. Methods A retrospective study was conducted on patients who underwent ATAAD repair at the Xiamen Cardiovascular Hospital, Xiamen University from 2020 to 2021, and their clinical data were analyzed. Results A total of 255 patients were included, with 200 males and 55 females, and an average age of (52.80±12.46) years. The incidence of acute kidney injury (AKI) after ATAAD repair was 43.9%. Dissection involving the renal artery [OR=2.144, 95%CI (1.234, 3.765), P=0.007], intraoperative urine output [OR=0.761, 95%CI (0.625, 0.911), P=0.004], and intraoperative red blood cell transfusion [OR=1.288, 95%CI (1.088, 1.543), P=0.004] were significantly associated with early AKI after ATAAD repair. Long-term renal function follow-up data were available for 232 patients, among whom 40 (17.2%) patients developed chronic kidney disease (CKD). Independent predictors for CKD included lower body mass index [OR=0.827, 95%CI (0.723, 0.931), P=0.003], preoperative cardiac tamponade [OR=5.344, 95%CI (1.65, 17.958), P=0.005], preoperative renal hypoperfusion syndrome [OR=12.629, 95%CI (5.003, 35.373), P<0.001], postoperative peak serum creatinine time>3 d [OR=7.566, 95%CI (2.799, 22.731), P<0.001], and AKI grade [grade 1: OR=4.418, 95%CI (1.339, 15.361), P=0.016; grade 2: OR=8.345, 95%CI (1.762, 40.499), P=0.007; grade 3: OR=9.463, 95%CI (2.602, 37.693), P<0.001]. Conclusion AKI related to ATAAD repair can recover in the early postoperative period, but both the duration and severity of AKI will affect long-term renal function. In addition, patients' nutritional status, preoperative cardiac tamponade, and renal hypoperfusion syndrome are also independent risk factors for long-term renal dysfunction.
