Trends in Kidney Function and Chronic Kidney Disease after Surgery for Acute Type A Aortic Dissection

Danial Ahmad; Michel Pompeu Sá; Carlos E Diaz Castrillon; Floyd Thoma; Yisi Wang; David Kaczorowski; Julie Phillippi; David West; Pyongsoo Yoon; Johannes Bonatti; Danny Chu; Derek Serna-Gallegos; Ibrahim Sultan

doi:10.1016/j.avsg.2024.11.098

Trends in Kidney Function and Chronic Kidney Disease after Surgery for Acute Type A Aortic Dissection

Ann Vasc Surg. 2024 Dec 15:112:139-147. doi: 10.1016/j.avsg.2024.11.098. Online ahead of print.

Affiliations

¹ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh.
² Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh.
³ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh.
⁴ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh. Electronic address: [email protected].

PMID: 39681215
DOI: 10.1016/j.avsg.2024.11.098

Abstract

Background: We sought to assess the effect of postoperative renal failure (RF) on outcomes of acute type A aortic dissection (ATAAD) and identify predictors of chronic kidney disease (CKD) following ATAAD.

Methods: This retrospective single-center analysis included all adults with ATAAD from 2011 to 2023. Patients were stratified into RF and no RF groups. Logistic regression analyses were performed to identify predictors of CKD. A linear mixed effect regression model was created to identify the differences in glomerular filtration rate (GFR) change over time.

Results: A total of 515 patients comprising 39.6% women were included in this analysis. Estimated GFR at admission was lower in the RF group (59 vs. 65 mL/min/1.73 m², P = 0.04) while 30-day mortality was higher in the RF group (17.4% vs. 6.5%, P < 0.01). Rates of postoperative pneumonia (16.8% vs. 6.8%, P < 0.01), atrial fibrillation (61.1% vs. 30.8%, P < 0.01), and sepsis (6.3 vs. 1.5%, P < 0.01) were higher in the RF group. Creatinine at admission (odds ratio [OR]: 3.133, 95% confidence interval [CI] 1.539-6.379, P < 0.01) was associated with higher odds of developing CKD at 1 year. Creatinine at admission (OR: 2.512, 95% CI 1.035-6.096, P = 0.04), and atrial fibrillation (OR: 3.698, 95% CI 1.237-11.056, P = 0.02) were associated with higher odds of developing CKD at 5 years.

Conclusions: ATAAD-related postoperative RF is associated with significant morbidity and mortality; however, it is not predictive of CKD. Creatinine at admission was the most consistent predictor of CKD development at 1 and 5 years post-ATAAD.