Objectives: We sought to assess the effect of postoperative renal failure (RF) on outcomes and identify predictors of chronic kidney disease (CKD) post-ATAAD.
Methods: This retrospective single-center analysis included all adults with ATAAD from 2011-2023. Patients were stratified into renal failure (RF) and no RF groups. Logistic regression analysis were performed to identify predictors of CKD. A linear mixed effect regression model was created to identify the differences in GFR change over time.
Results: A total of 515 patients were included in this analysis of which women comprised 39.6%. Estimated glomerular filtration rate (GFR) at admission was lower in the RF group (59 vs 65 mL/min/1.73m2, p=0.04) while 30-day mortality was higher in the RF group (17.4% vs 6.5%, p<0.001). Rates of postoperative pneumonia (16.8% vs 6.8%, p<0.001) and atrial fibrillation (61.1% vs 30.8%, p<0.001), and sepsis (6.3 vs 1.5%, p=0.0034) were higher in the RF group. Creatinine at admission (OR: 3.133, 95% CI 1.539-6.379, p=0.002) 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: Acute type A aortic dissection-related postoperative renal failure is associated with significant morbidity and mortality; however, it is not predictive of chronic kidney disease. Creatinine at admission was the most consistent predictor of CKD development at 1 and 5 years post-ATAAD.
Keywords: ATAAD; Aorta; Chronic Kidney Disease; Renal Function; Type A Aortic Dissection.
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