Incidence and transition of acute kidney injury, acute kidney disease to chronic kidney disease after acute type a aortic dissection surgery

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.