Risk factors for predicting continuous renal replacement therapy in patients with acute renal injury after surgical treatment of Stanford type A aortic dissection

Objective To identify factors influencing continuous renal replacement therapy (CRRT) in patients with acute renal injury (AKI) after aortic Stanford type A aortic dissection. Methods Clinical data of 1378 patients with Stanford type A aortic dissection who underwent surgical treatment in our center from January 2010 to December 2017 were retrospectively collected. The surgical method was selected according to the extent of dissection involved and the characteristics of aortic root lesions. The perioperative and operative factors of the two groups were collected and analyzed. Results The incidence of CRRT was 8.3% (115/1378). There were 91 (7.0%) cases of early mortality and 47 (41.6%) deaths in the CRRT group. In comparison 44 (3.7%) deaths were recorded in the non-CRRT group. Univariate analysis revealed significant differences in the following preoperative indicators between the two groups: age, preoperative creatinine elevation (>130 umol/L), preoperative acute liver injury, previous chronic kidney disease history, preoperative white blood cell count, platelet count, emergency surgery, concurrent coronary artery bypass grafting surgery, total arch replacement, blood loss, red blood cell (RBC) transfusion, platelet transfusion, plasma transfusion, surgical time, cardiopulmonary bypass time, and aortic blocking time. Logistics multivariate regression analysis showed that patients with senior age, preoperative liver damage, and high volume of RBC transfusion were independent risk factors influencing the occurrence of severe AKI requiring CRRT treatment. Conclusion Advanced age, preoperative liver damage, and high RBC transfusion volume are independent risk factors contributing to postoperative CRRT. Those factors should be monitored during operation to protect renal function and reduce the risk of AKI.