Key result
CKD in type A aortic dissection repair links to higher MACE despite similar in-hospital mortality.
Why the study?
While chronic kidney disease is known to increase mortality in aortic diseases, its impact on outcomes following type A aortic dissection repair has not been thoroughly investigated.
Does chronic kidney disease increase the risk of in-hospital complications in patients undergoing type A aortic dissection repair?
Observational (n=4,282)
Yes
Does chronic kidney disease increase the risk of in-hospital complications in patients undergoing type A aortic dissection repair?
Effect estimate: aOR 0.883 (95% CI 0.671-1.163)
p-value: p=0.38
Chronic kidney disease is a significant risk factor for postoperative complications, particularly cardiac and renal events, following type A aortic dissection repair, although it does not significantly impact in-hospital mortality.
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Warrants heightened vigilance for MACE and AKI in CKD patients; extends risk factor associations to type A aortic dissection repair.
BackgroundWhile 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.MethodsPatients 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.ResultsThere 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.ConclusionCKD 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.
Li et al. (2026) conducted an observational in Type A aortic dissection (n=4,282). Chronic kidney disease vs. No chronic kidney disease was evaluated on In-hospital mortality (aOR 0.883, 95% CI 0.671-1.163, p=0.38). Chronic kidney disease in patients undergoing type A aortic dissection repair was associated with similar in-hospital mortality (aOR 0.883; 95% CI 0.671-1.163; P=0.38) but higher risk of MACE.
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