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. 2021 Oct 18;10(20):4769.
doi: 10.3390/jcm10204769.

Incidence and Transition of Acute Kidney Injury, Acute Kidney Disease to Chronic Kidney Disease after Acute Type A Aortic Dissection Surgery

Chih-Hsiang Chang  1   2 , Shao-Wei Chen  3   4 , Jia-Jin Chen  1 , Yi-Hsin Chan  5 , Chieh-Li Yen  1 , Tao Han Lee  1 , Yu-Ting Cheng  3
Affiliations

Incidence and Transition of Acute Kidney Injury, Acute Kidney Disease to Chronic Kidney Disease after Acute Type A Aortic Dissection Surgery

Chih-Hsiang Chang et al. J Clin Med. .

Abstract

Acute kidney disease (AKD) is the persistence of renal injury between days 8 and 90 after an initial acute kidney injury (AKI). In this study, we aimed to explore the incidence of AKD, the association between AKD, and patient outcomes after acute type A aortic dissection (type A AAD) surgery. We identified 696 participants who underwent type A AAD surgery. Patients were categorized into stages 1 to 3 or 0 (non-AKD) AKD groups. Outcomes included major adverse kidney events (MAKEs), respiratory failure, all-cause readmission, and ischemic stroke from day 91 after operation. A total of 376 (54%) participants developed AKI, and 135/376 (35.9%) developed AKD. Moreover, 34/320 (10.6%) patients without AKI still developed AKD. Overall, 169/696 (24.3%) participants developed AKD. Patients with stages 2 and 3 AKD are associated with persisted declined renal function within 1 year. AKD was associated with a higher risk of MAKEs (hazard ratio (HR): 2.52, 95% confidence interval (CI) 1.90-3.33) and all-cause readmission (HR: 2.86, 95% CI: 2.10-3.89). Development of AKD with or without AKI is associated with a higher risk of MAKEs and hospitalization after acute aortic dissection surgery. Higher-stage AKD is associated with a trend of persistent decline in kidney function.

Keywords: acute kidney disease; acute kidney injury; aortic dissection; cardiovascular surgery.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Diagram of patient selection. AKI, acute kidney injury; AKD, acute kidney disease.
Figure 2
Figure 2
Kidney function trajectory after acute kidney injury and acute kidney disease. (A) Trend of creatinine levels after operation according to AKI stage. AKI, acute kidney injury. Creatinine or eGFR data after dialysis initiation were not included in the figure. AKD, acute kidney disease; eGFR, estimated glomerular filtration rate. (B) Trend of eGFR after operation according to AKD stage. Creatinine or eGFR data after dialysis initiation were not included in the figure. AKD, acute kidney disease; eGFR, estimated glomerular filtration rate.
Figure 2
Figure 2
Kidney function trajectory after acute kidney injury and acute kidney disease. (A) Trend of creatinine levels after operation according to AKI stage. AKI, acute kidney injury. Creatinine or eGFR data after dialysis initiation were not included in the figure. AKD, acute kidney disease; eGFR, estimated glomerular filtration rate. (B) Trend of eGFR after operation according to AKD stage. Creatinine or eGFR data after dialysis initiation were not included in the figure. AKD, acute kidney disease; eGFR, estimated glomerular filtration rate.
Figure 3
Figure 3
Directly adjusted one minus survival rates of MAKEs (A) and newly diagnosed CKD (B) after type A acute aortic dissection surgery in patients with or without AKD. MAKEs, major adverse kidney events; CKD, chronic kidney disease.
See this image and copyright information in PMC

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