Can Renal Resistive Index Predict Acute Kidney Injury After Acute Type A Aortic Dissection Repair?

Objectives. This study is aimed to evaluate the efficiency in early prediction of postoperative persistent acute kidney injury (PAKI) after surgery in acute Stanford type A aortic dissection (AAAD) patients by using Doppler renal resistive index (RRI) and semiquantitative color (SQC) Doppler grade, respectively. Methods. 84 AAAD patients received Sun’s surgical management, and 67 patients were enrolled. RRI and SQC Doppler grade were evaluated by ultrasonography, respectively, at 6 hours after surgery. Serum creatinine (sCr) was recorded before operation and at 24 hours, 48 hours, and 72 hours after operation. AKI grade was evaluated according to the classifications of the Acute Kidney Injury Network (AKIN). PAKI is defined as persistent oliguria and/or sCr elevation after 3 days. RRI and SQC Doppler grade were compared, respectively, between the PAKI and non-PAKI groups. Potential predictors were first tested by univariate logistic regression analysis, and a multivariate model was identified to determine the independent predictive ability of RRI and SQC Doppler grade for the PAKI. Receiver operating characteristic (ROC) analysis was performed to compare the diagnostic accuracy between RRI and SQC Doppler grade in early prediction of PAKI by using AKIN classifications as the reference standard. Results. Of a total of 67 patients enrolled during the study period, 21 (31.3%) patients suffered from PAKI and 8 (11.9%) patients required dialysis. There are significant differences in RRI (0.80 ± 0.09 vs. 0.70 ± 0.05, P=0.002) and SQC Doppler grade (x2=12.193, P=0.007) between the 2 groups with and without PAKI. Univariate analysis showed that RRI, SQC Doppler grade, length of stay in ICU, time of CPB, and length of stay in hospital were significant predictors of PAKI. RRI and the SQC Doppler grade remained independent predictors of PAKI. Area under the curve (AUC) of RRI was 0.855 (95% CI, 0.74–0.96) with cutoff value 0.725 (sensitivity 90.9% and specificity 71.1%), AUC of SQC Doppler grade was 0.642 (95% CI, 0.49–0.79) with cutoff value grade 2 (sensitivity 50% and specificity 73.3%). Conclusion. Both postoperative RRI and SQC Doppler grade are independent predictors for PAKI after surgery in AAAD patients. Both postoperative RRI and SQC Doppler grade can be obtained rapidly by bedside ultrasound, which is a good tool for early prediction for postoperative PAKI.

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Faculty Opinions recommendation of Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726480019.793520508 ◽

2016 ◽

Author(s):

John Augoustides

Keyword(s):

Acute Kidney Injury ◽

Aortic Dissection ◽

Kidney Injury ◽

Type A ◽

Acute Type ◽

Term Survival ◽

Type A Aortic Dissection ◽

Long Term Survival

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Preoperative renal malperfusion is an independent predictor for acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa063 ◽

2020 ◽

Vol 58 (2) ◽

pp. 302-308

Author(s):

Kosaku Nishigawa ◽

Toshihiro Fukui ◽

Kohei Uemura ◽

Shuichiro Takanashi ◽

Tomoki Shimokawa

Keyword(s):

Acute Kidney Injury ◽

Aortic Dissection ◽

Odds Ratio ◽

Independent Predictor ◽

Kidney Injury ◽

Type A ◽

Acute Type ◽

Operative Death ◽

Type A Aortic Dissection ◽

Late Mortality

Abstract OBJECTIVES This study was aimed to investigate the impact of preoperative renal malperfusion on early and late outcomes after surgery for acute type A aortic dissection (AAAD). METHODS Of 915 patients who underwent surgery for AAAD between September 2004 and September 2017, we enrolled 534 patients whose preoperative enhanced computed tomography images were retrospectively available in this study. Exclusion criteria were single kidney (n = 3) and dialysis-dependent preoperatively (n = 12). We compared early and late outcomes between patients who had preoperative renal malperfusion (n = 64) and those who did not have renal malperfusion (n = 470). RESULTS The incidence of postoperative acute kidney injury, defined using the Kidney Disease: Improving Global Outcomes criteria, was higher in the renal malperfusion group than in the no renal malperfusion group (76.6% vs 39.4%; P < 0.001). Similarly, operative death was more frequently seen in the renal malperfusion group (12.5% vs 3.8%; P = 0.003). Multivariate analyses showed that renal malperfusion was the independent predictor for postoperative acute kidney injury [odds ratio 4.32, 95% confidence interval (CI) 2.25–8.67; P < 0.001] and operative death (odds ratio 3.08, 95% CI 1.02–8.86; P = 0.046). The median follow-up period in the hospital survivors was 3.3 years (interquartile range 2.1–6.7 years). The cumulative survival rate at 8 years was similar between the groups (74.6% in the renal malperfusion group and 76.0% in the no renal malperfusion group; P = 0.349). CONCLUSIONS Preoperative renal malperfusion is an independent predictor for postoperative acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection.

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Significance of preoperative acute kidney injury in patients with acute type A aortic dissection

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2018.09.003 ◽

2019 ◽

Vol 118 (4) ◽

pp. 815-820 ◽

Cited By ~ 1

Author(s):

Tsu-Ming Chien ◽

Hao Wen ◽

Jiann-Woei Huang ◽

Chong-Chao Hsieh ◽

Huai-Min Chen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Aortic Dissection ◽

Kidney Injury ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2016.05.006 ◽

2016 ◽

Vol 102 (6) ◽

pp. 2003-2009 ◽

Cited By ~ 22

Author(s):

Yusuke Sasabuchi ◽

Naoyuki Kimura ◽

Junji Shiotsuka ◽

Tetsuya Komuro ◽

Hideyuki Mouri ◽

...

Keyword(s):

Acute Kidney Injury ◽

Aortic Dissection ◽

Kidney Injury ◽

Type A ◽

Acute Type ◽

Term Survival ◽

Type A Aortic Dissection ◽

Long Term Survival

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Successful Repair of Acute Type B and Retrograde Type A Aortic Dissection With Kidney Ischemia

Vascular and Endovascular Surgery ◽

10.1177/1538574417708133 ◽

2017 ◽

Vol 51 (5) ◽

pp. 342-345 ◽

Cited By ~ 1

Author(s):

Jeko M. Madjarov ◽

Michael G. Katz ◽

Hector Crespo-Soto ◽

Svetozar Madzharov ◽

Timothy Roush ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Aortic Dissection ◽

Renal Artery ◽

Kidney Injury ◽

Renal Ischemia ◽

Left Renal Artery ◽

Acute Type ◽

Type B ◽

Type A Aortic Dissection

Acute dissection of thoracic aorta carries a risk of renal ischemia followed by the development of a kidney failure. The optimal surgical and nonsurgical management of these patients, timing of intervention, and the factors predicting renal recovery are not well delineated and remain controversial. We present a case of acute type B thoracic aortic dissection with left kidney ischemia. Evaluation of renal function was performed by the means of internationally accepted Risk, Injury, Failure, Loss of kidney function, End stage kidney disease and Acute Kidney Injury Network classifications for acute kidney injury, renal duplex sonography, and intravascular ultrasound that demonstrated left renal artery dissection with a flap completely compressing the true lumen. The patient underwent thoracic endovascular aortic repair and left renal artery stent and recovered well. Six months later, at the follow-up visit, retrograde type A aortic dissection was found, which was successfully repaired. Reversal of renal ischemia after aortic dissection depends on the precise assessment of renal function and prompt intervention.

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