Annals of vascular surgery · 2024
Trends in Kidney Function and Chronic Kidney Disease after Surgery for Acute Type A Aortic Dissection.
СтатьяНазвание и аннотация: Перевод в очереди
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Ahmad Danial, Sá Michel Pompeu, Diaz Castrillon Carlos E, Thoma Floyd, Wang Yisi, Kaczorowski David, Phillippi Julie, West David, Yoon Pyongsoo, Bonatti Johannes, Chu Danny, Serna-Gallegos Derek, Sultan Ibrahim
Аннотация
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.
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.