Perioperative risk factors for chronic kidney disease after acute type A aortic dissection repair: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAN Pianpian ¹ , WU Xijie ² ,  GUO Shengwen ¹ , HUANG Yiting ¹ , LU Meili ¹ , JIANG Lulu ¹ , ZHOU Yanqing ¹ , MA Jiarong ¹

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;

Corresponding author：

GUO Shengwen, Email: fwguoshengwen@163.com

Keywords：

Acute kidney injury; acute type A aortic dissection; chronic kidney disease; renal recovery; renal hypoperfusion syndrome

DOI：

10.7507/1007-4848.202406023

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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 56.1%. 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.

1.	Pan H, Shi Z, Wang S, et al. A predictive model of 30-day mortality in patients with acute type A aortic dissection. Eur J Radiol, 2024, 175: 111469.
2.	生伟, 王祯宝, 牛兆倬, 等. 急性StanfordA型主动脉夹层患者术后急性肾损伤及其对预后的影响. 中国胸心血管外科临床杂志, 2023, 30(12): 1725-1730.Sheng W, Wang ZB, Niu ZZ, et al, Incidence of postoperative acute kidney injury and risk factors for prognosis in patients with acute Stanford type A aortic dissection. Chin J Clin Thorac Cardiovasc Surg, 2023, 30 (12): 1725-1730.
3.	Li R, Prastein D. Female patients have higher in-hospital mortality after type A aortic dissection repair: A population study from the national inpatient sample. World J Surg, 2024, 48(7): 1783-1790.
4.	Chen S, Zhang C, Zhong Y, et al. Association between preoperative serum myoglobin and acute kidney injury after Stanford type A aortic dissection surgery. Clin Chim Acta, 2023, 541: 117232.
5.	刘钦东, 管玉龙, 杨晓芳, 等. 心脏手术相关急性肾损伤近五年防治进展. 中国体外循环杂志, 2023, 21(6): 368-372.Liu QD, Guan YL, Yang XF, et al. Progress in prevention and treatment of cardiac surgery-associated acute kidney injury in recent five years. Chin J Extracorpor Circ, 2023, 21(6): 368-372.
6.	Helgason D, Helgadottir S, Ahlsson A, et al. Acute kidney injury after acute repair of type A aortic dissection. Ann Thorac Surg, 2021, 111(4): 1292-1298.
7.	Lacquaniti A, Ceresa F, Campo S, et al. Surgical aortic valve replacement and renal dysfunction: From acute kidney injury to chronic disease. J Clin Med, 2024, 13(10): 2933.
8.	Privratsky JR, Krishnamoorthy V, Raghunathan K, et al. Postoperative acute kidney injury is associated with progression of chronic kidney disease independent of severity. Anesth Analg, 2022, 134(1): 49-58.
9.	李慧霞, 车若琛, 张爱华. 细胞周期停滞: AKI向CKD转变的关键点. 生物医学转化, 2021, 2(1): 55-63.Li HX, Che RC, Zhang AH, et al. Cell cycle arrest: A key point of AKI-to-CKD transition. Biomed Transform, 2021, 2(1): 55-63.
10.	Stai S, Lioulios G, Christodoulou M, et al. From KDIGO 2012 towards KDIGO 2021 in idiopathic membranous nephropathy guidelines: What has changed over the last 10 years? J Nephrol, 2023, 36(2): 551-561.
11.	Utsumi S, Kondo Y, Harada Y, et al. Evaluation of a creatinine clearance correction equation based on body fat mass in older Japanese patients with diabetes. Front Med (Lausanne), 2024, 11: 1228383.
12.	Riley R, Snell KIE, Ensor J, et al. Minimum sample size for developing a multivariable prediction model: PARTⅡ: Binary and time-to-event outcomes. Stat Med, 2019, 38(7): 1276-1296.
13.	Choe SH, Cho H, Bae J, et al. Severity and duration of acute kidney injury and chronic kidney disease after cardiac surgery. J Clin Med, 2021, 10(8): 1556.
14.	Legouis D, Galichon P, Bataille A, et al. Rapid occurrence of chronic kidney disease in patients experiencing reversible acute kidney injury after cardiac surgery. Anesthesiology, 2017, 126(1): 39-46.
15.	Lee Y, Park J, Jang MJ, et al. Development of model to predict end-stage renal disease after coronary artery bypass grafting: The ACHE score. Medicine (Baltimore), 2019, 98(21): e15789.
16.	Wang L, Zhong G, Lv X, et al. Risk factors for acute kidney injury after Stanford type A aortic dissection repair surgery: A systematic review and meta-analysis. Ren Fail, 2022, 44(1): 1462-1476.
17.	Sheng W, Xia W, Niu Z, et al. Incidence of acute kidney injury and risk factors of prognosis in patients with acute stanford type A aortic dissection. Ann Thorac Cardiovasc Surg, 2023, 29(5): 249-255.
18.	Norton EL, Longi FN, Wu X, et al. Renal dysfunction at discharge and long-term survival in acute type A aortic dissection. J Surg Res, 2024, 296: 472-480.
19.	Yu SM, Bonventre JV. Acute kidney injury and maladaptive tubular repair leading to renal fibrosis. Curr Opin Nephrol Hypertens, 2020, 29(3): 310-318.
20.	Rayego-Mateos S, Marquez-Expósito L, Rodrigues-Diez R, et al. Molecular mechanisms of kidney injury and repair. Int J Mol Sci, 2022, 23(3): 1542.
21.	Wang C, Li SW, Zhong X, et al. An update on renal fibrosis: From mechanisms to therapeutic strategies with a focus on extracellular vesicles. Kidney Res Clin Pract, 2023, 42(2): 174-187.
22.	Huang MJ, Ji YW, Chen JW, et al. Targeted VEGFA therapy in regulating early acute kidney injury and late fibrosis. Acta Pharmacol Sin, 2023, 44(9): 1815-1825.
23.	Zimmermann S, Mathew A, Schöppe R, et al. Fat tissue quantity, waist circumference or waist-to-hip ratio in patients with chronic kidney disease: A systematic review and meta-analysis. Obes Res Clin Pract, 2024, 18(2): 81-87.
24.	El-Andari R, Bozso SJ, Kang JJH, et al. Heart valve surgery and the obesity paradox: A systematic review. Clin Obes, 2022, 12(2): e12506.
25.	Adler Y, Ristić AD, Imazio M, et al. Cardiac tamponade. Nat Rev Dis Primers, 2023, 9(1): 36.
26.	Watchorn J, Huang D, Bramham K, et al. Decreased renal cortical perfusion, independent of changes in renal blood flow and sublingual microcirculatory impairment, is associated with the severity of acute kidney injury in patients with septic shock. Crit Care, 2022, 26(1): 261.
27.	Qian SC, Ma WG, Pan XD, et al. Renal malperfusion affects operative mortality rather than late death following acute type A aortic dissection repair. Asian J Surg, 2020, 43(1): 213-219.
28.	Arnaoutakis GJ, Ogami T, Patel HJ, et al. Acute kidney injury in patients undergoing surgery for type A acute aortic dissection. Ann Thorac Surg, 2023, 115(4): 879-885.
29.	Cho YH, Sung K, Kim WS, et al. Malperfusion syndrome without organ failure is not a risk factor for surgical procedures for type A aortic dissection. Ann Thorac Surg, 2014, 98(1): 59-64.

1. Pan H, Shi Z, Wang S, et al. A predictive model of 30-day mortality in patients with acute type A aortic dissection. Eur J Radiol, 2024, 175: 111469.
2. 生伟, 王祯宝, 牛兆倬, 等. 急性StanfordA型主动脉夹层患者术后急性肾损伤及其对预后的影响. 中国胸心血管外科临床杂志, 2023, 30(12): 1725-1730.Sheng W, Wang ZB, Niu ZZ, et al, Incidence of postoperative acute kidney injury and risk factors for prognosis in patients with acute Stanford type A aortic dissection. Chin J Clin Thorac Cardiovasc Surg, 2023, 30 (12): 1725-1730.
3. Li R, Prastein D. Female patients have higher in-hospital mortality after type A aortic dissection repair: A population study from the national inpatient sample. World J Surg, 2024, 48(7): 1783-1790.
4. Chen S, Zhang C, Zhong Y, et al. Association between preoperative serum myoglobin and acute kidney injury after Stanford type A aortic dissection surgery. Clin Chim Acta, 2023, 541: 117232.
5. 刘钦东, 管玉龙, 杨晓芳, 等. 心脏手术相关急性肾损伤近五年防治进展. 中国体外循环杂志, 2023, 21(6): 368-372.Liu QD, Guan YL, Yang XF, et al. Progress in prevention and treatment of cardiac surgery-associated acute kidney injury in recent five years. Chin J Extracorpor Circ, 2023, 21(6): 368-372.
6. Helgason D, Helgadottir S, Ahlsson A, et al. Acute kidney injury after acute repair of type A aortic dissection. Ann Thorac Surg, 2021, 111(4): 1292-1298.
7. Lacquaniti A, Ceresa F, Campo S, et al. Surgical aortic valve replacement and renal dysfunction: From acute kidney injury to chronic disease. J Clin Med, 2024, 13(10): 2933.
8. Privratsky JR, Krishnamoorthy V, Raghunathan K, et al. Postoperative acute kidney injury is associated with progression of chronic kidney disease independent of severity. Anesth Analg, 2022, 134(1): 49-58.
9. 李慧霞, 车若琛, 张爱华. 细胞周期停滞: AKI向CKD转变的关键点. 生物医学转化, 2021, 2(1): 55-63.Li HX, Che RC, Zhang AH, et al. Cell cycle arrest: A key point of AKI-to-CKD transition. Biomed Transform, 2021, 2(1): 55-63.
10. Stai S, Lioulios G, Christodoulou M, et al. From KDIGO 2012 towards KDIGO 2021 in idiopathic membranous nephropathy guidelines: What has changed over the last 10 years? J Nephrol, 2023, 36(2): 551-561.
11. Utsumi S, Kondo Y, Harada Y, et al. Evaluation of a creatinine clearance correction equation based on body fat mass in older Japanese patients with diabetes. Front Med (Lausanne), 2024, 11: 1228383.
12. Riley R, Snell KIE, Ensor J, et al. Minimum sample size for developing a multivariable prediction model: PARTⅡ: Binary and time-to-event outcomes. Stat Med, 2019, 38(7): 1276-1296.
13. Choe SH, Cho H, Bae J, et al. Severity and duration of acute kidney injury and chronic kidney disease after cardiac surgery. J Clin Med, 2021, 10(8): 1556.
14. Legouis D, Galichon P, Bataille A, et al. Rapid occurrence of chronic kidney disease in patients experiencing reversible acute kidney injury after cardiac surgery. Anesthesiology, 2017, 126(1): 39-46.
15. Lee Y, Park J, Jang MJ, et al. Development of model to predict end-stage renal disease after coronary artery bypass grafting: The ACHE score. Medicine (Baltimore), 2019, 98(21): e15789.
16. Wang L, Zhong G, Lv X, et al. Risk factors for acute kidney injury after Stanford type A aortic dissection repair surgery: A systematic review and meta-analysis. Ren Fail, 2022, 44(1): 1462-1476.
17. Sheng W, Xia W, Niu Z, et al. Incidence of acute kidney injury and risk factors of prognosis in patients with acute stanford type A aortic dissection. Ann Thorac Cardiovasc Surg, 2023, 29(5): 249-255.
18. Norton EL, Longi FN, Wu X, et al. Renal dysfunction at discharge and long-term survival in acute type A aortic dissection. J Surg Res, 2024, 296: 472-480.
19. Yu SM, Bonventre JV. Acute kidney injury and maladaptive tubular repair leading to renal fibrosis. Curr Opin Nephrol Hypertens, 2020, 29(3): 310-318.
20. Rayego-Mateos S, Marquez-Expósito L, Rodrigues-Diez R, et al. Molecular mechanisms of kidney injury and repair. Int J Mol Sci, 2022, 23(3): 1542.
21. Wang C, Li SW, Zhong X, et al. An update on renal fibrosis: From mechanisms to therapeutic strategies with a focus on extracellular vesicles. Kidney Res Clin Pract, 2023, 42(2): 174-187.
22. Huang MJ, Ji YW, Chen JW, et al. Targeted VEGFA therapy in regulating early acute kidney injury and late fibrosis. Acta Pharmacol Sin, 2023, 44(9): 1815-1825.
23. Zimmermann S, Mathew A, Schöppe R, et al. Fat tissue quantity, waist circumference or waist-to-hip ratio in patients with chronic kidney disease: A systematic review and meta-analysis. Obes Res Clin Pract, 2024, 18(2): 81-87.
24. El-Andari R, Bozso SJ, Kang JJH, et al. Heart valve surgery and the obesity paradox: A systematic review. Clin Obes, 2022, 12(2): e12506.
25. Adler Y, Ristić AD, Imazio M, et al. Cardiac tamponade. Nat Rev Dis Primers, 2023, 9(1): 36.
26. Watchorn J, Huang D, Bramham K, et al. Decreased renal cortical perfusion, independent of changes in renal blood flow and sublingual microcirculatory impairment, is associated with the severity of acute kidney injury in patients with septic shock. Crit Care, 2022, 26(1): 261.
27. Qian SC, Ma WG, Pan XD, et al. Renal malperfusion affects operative mortality rather than late death following acute type A aortic dissection repair. Asian J Surg, 2020, 43(1): 213-219.
28. Arnaoutakis GJ, Ogami T, Patel HJ, et al. Acute kidney injury in patients undergoing surgery for type A acute aortic dissection. Ann Thorac Surg, 2023, 115(4): 879-885.
29. Cho YH, Sung K, Kim WS, et al. Malperfusion syndrome without organ failure is not a risk factor for surgical procedures for type A aortic dissection. Ann Thorac Surg, 2014, 98(1): 59-64.

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