Chronic Kidney Disease Is Associated With a Higher Risk of Complications in Type a Aortic Dissection Repair: A Population Study of National Inpatient Sample From 2015-2020

Abstract

Background

While chronic kidney disease (CKD) has been identified as a risk factor for mortality in patients with aortic diseases, its impact on the outcomes of type A aortic dissection (TAAD) repair has not yet been thoroughly investigated. This study aimed to conduct a comprehensive, population-based analysis of the association of CKD with in-hospital outcomes following TAAD repair.

Methods

Patients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients with and without CKD while adjusting for demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status. Additional subgroup analyses compared mild, moderate, and severe CKD patients vs non-CKD patients.

Results

There were 800 (18.68%) CKD patients and 3482 (81.32%) non-CKD patients who underwent TAAD repair. Patients with and without CKD had comparable in-hospital mortality (aOR = 0.883, 95 CI = 0.671-1.163, P = .38) and there was no difference in the transfer-in status or indication of delay from admission to operation. Patients with CKD had higher risks of major adverse cardiovascular event (MACE; aOR = 1.519, 95 CI = 1.115-2.069, P = .01), myocardial infarction (MI; aOR = 1.693, 95 CI = 1.135-2.524, P = .01), cardiogenic shock (aOR = 1.422, 95 CI = 1.136-1.779, P < 0.01), mechanical ventilation (aOR = 1.346, 95 CI = 1.109-1.634, P < .01), and acute kidney injury (AKI; aOR = 1.933, 95 CI = 1.596-2.343, P < .01). However, CKD patients had a lower rate of pacemaker implantation (aOR = 0.384, 95 CI = 0.167-0.882, P = .02). Subgroup analyses demonstrated that compared to those without CKD, mild-CKD patients had largely comparable outcomes, moderate-CKD patients had higher AKI, and severe-CKD patients had higher cardiac complications.

Conclusion

CKD is a significant risk factor for postoperative complications following TAAD repair. It is essential to closely monitor and manage organ system complications, particularly cardiac and renal complications, in patients with severe and moderate CKD undergoing TAAD repair.