Acute Kidney Injury in Acute Type B Aortic Dissection: Outcomes Over 20 Years.

BACKGROUND: Mechanisms contributing to acute kidney injury (AKI) after acute type B aortic dissection (ABAD) include renal malperfusion or underlying renal dysfunction. We characterized AKI after ABAD and evaluated its potential for adverse clinical and aortic outcomes.

METHODS: 478 patients without prior dialysis requirement (mean age 62.1 years, 60.5% male) presented with ABAD (1995-2016). Renal malperfusion was identified in 87 (18.2%). AKI was assessed by the KDIGO criteria.

RESULTS: AKI was seen in 252 (52.7%; stage 1=130, stage 2=71, stage 3=51), and was associated with increased hospitalization (11 days versus 7 days with no AKI, p=0.008). Independent predictors of AKI included hypertension (OR 1.69), CKD (OR 3.98), CHF (OR 2.36) and visceral (OR 2.19), renal (OR 3.18), or limb malperfusion (OR 2.18, all p<0.05). Early mortality occurred in 44 (9.2%) and was independently predicted by stages 2 (OR 4.38) and 3 AKI (OR 6.30, both p<0.03). 10-year survival was 46.5%, and independent predictors of late mortality included aortic diameter (OR 1.02), COPD (OR 2.02), CKD (OR 3.51), and stages 2 (OR 2.74) and 3 AKI (OR 2.26, all p<0.01). 10-year freedom from aortic rupture, redissection, or need for reintervention was 39.8%. Independent predictors of late aortic events included hyperlipidemia (OR 1.55), diabetes (OR 0.38), aortic diameter (OR 1.03), and connective tissue disease (OR 2.54, all p<0.03), but not AKI (p=0.149).

CONCLUSIONS: AKI is common following ABAD and increases early mortality, hospital stay, and diminishes late survival. Despite its adverse impact on survival, AKI is not associated with late aortic events.