Impact of Acute Kidney Injury on Early to Long-Term Outcomes in Patients Who Underwent Surgery for Type A Acute Aortic Dissection

Ko, Toshiyuki; Higashitani, Michiaki; Sato, Akihiko; Uemura, Yukari; Norimatsu, Togo; Mahara, Keitaro; Takamisawa, Itaru; Seki, Atsushi; Shimizu, Jun; Tobaru, Tetsuya; Aramoto, Haruo; Iguchi, Nobuo; Fukui, Toshihiro; Watanabe, Masafumi; Nagayama, Masatoshi; Takayama, Morimasa; Takanashi, Shuichiro; Sumiyoshi, Tetsuya; Komuro, Issei; Tomoike, Hitonobu

doi:10.1016/j.amjcard.2015.04.043

Cited by 108 publications

(148 citation statements)

References 21 publications

(8 reference statements)

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“…One study reported on CV events after hospitalization in an intensive care unit and 5 studies reported on CV events after coronary artery bypass grafting (CABG). One study (not included in the meta-analysis) provided data on major adverse cardiac events after aortic surgery for type-A dissection [45] . Also, one study (not included in the meta-analysis) reported CV events after admission in intensive care (regardless of the underlying diagnosis) and development of AKI.…”

Section: Meta-analysismentioning

confidence: 99%

Intervention Associated Acute Kidney Injury and Long-Term Cardiovascular Outcomes

et al. 2015

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Background: Acute kidney injury (AKI) has been associated with all-cause short- and long-term mortality. However, its association with cardiovascular (CV) events remains unclear. We sought to investigate this in patients undergoing open (OAR) or endovascular (EVAR) abdominal aortic aneurysm repair, as they are likely to develop both AKI and CV morbidity. A meta-analysis was subsequently performed to confirm this in other CV-interventions. Methods: AKI-incidence was assessed in a multicentre-cohort of 1,068 patients undergoing EVAR (947 individuals) or OAR electively using the ‘Acute Kidney Injury Network' criteria. A composite-endpoint was used, consisting of non-fatal myocardial infarction (MI), stroke, vascular event, hospitalisation due to heart failure and CV death. A systematic literature review identified studies reporting AKI-incidence and CV events. Risk ratios (RRs) at 1 and 5 years were combined using meta-analysis. Results: During a median follow-up of 62 months (range 11-121), AKI was associated with CV events on adjusted (for CV risk-factors) analyses (Incidence 36% of EVAR, 32% of OAR patients; hazard ratio 1.73, 95% CI 1.06-3.39, p = 0.03) for the overall population. In the meta-analysis, 7 studies reported incidence of MI on 23,936 patients 1-year after coronary intervention (PCI) with a pooled RR of 1.76 (95% CI 1.45-2.83, p < 0.001); at 2 years, 3 studies reported MI incidence on 17,773 patients after PCI with a pooled RR of 1.34 (95% CI 1.10-1.63, p = 0.003). MI-incidence was reported 5 years after cardiac surgery by 3 studies (33,701 patients) with a pooled RR of 1.60 (95% CI 1.43-1.81). Conclusion: AKI is associated with long-term CV events after surgery or endovascular intervention.

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Section: Meta-analysismentioning

confidence: 99%

Intervention Associated Acute Kidney Injury and Long-Term Cardiovascular Outcomes

et al. 2015

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“…b There was a significant difference between the baseline sCr and peak sCr in the AKI group. There was also a significant difference between groups in the peak sCr aortic surgery for Stanford type A dissection reported that AKI worsened the in-hospital, 30-day, and 1-year mortality [8,12]. Another study on the incidence and risk factors for AKI after DeBakey type III aortic dissection also reported that AKI worsened mortality, because in-hospital complications were higher in patients with AKI [20].…”

Section: Discussionmentioning

confidence: 89%

“…A retrospective study regarding the incidence and risk factors for AKI after thoracic aortic surgery for aortic dissection determined that preoperative sCr level and cardiopulmonary bypass duration longer than 180 min were independent risk factors for AKI [8]. In another study, extracorporeal circulation time, body mass index, perioperative peak serum C-reactive protein concentration, renal malperfusion, and perioperative sepsis were risk factors for AKI in patients with Stanford type A aortic dissection who underwent surgery [12]. Another study about on the incidence and risk factors of for AKI after DeBakey type III aortic dissection determined that a history of hypertension, electrocardiographic ST-T changes, DeBakey type IIIb, and sCr level on admission were risk factors for AKI [20].…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for acute kidney injury after initial acute aortic dissection and their effect on long-term mortality

et al. 2016

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Background: Several reports have discussed the risk factors for acute kidney injury (AKI) after thoracic aortic surgery and aortic dissection and the increased mortality in patients with AKI. However, there are few reports on the risk factors for AKI with combined medical and surgical treatment and the influence on mortality. The aim of this study was to clarify the risk factors and long-term effects of AKI on mortality and kidney function after acute aortic dissection in a cohort at our hospital. Methods: We retrospectively investigated 96 patients with initial acute aortic dissection between April 2012 and January 2015. We divided the subjects into two groups: 65 with AKI and 31 without AKI using RIFLE criteria. The outcomes were all-cause mortality and the decrease in kidney function after 6 and 12 months. We extracted the risk factors for AKI by multivariate logistic regression using clinical parameters. Results: A history of hypertension, type A aortic dissection, and low platelet levels were statistically significant factors to predict AKI after aortic dissection (odds ratio [OR] 9.1, 95 % confidence interval [CI] 1.42-58.5, p = 0.02; OR 25.2, 95 % CI 3.1-205.0, p = 0.003; OR 0.82, 95 % CI 0.68-0.98, p = 0.033, respectively). Three patients with AKI died and 1 patient recovered from AKI. The kidney function in survivors was similar in those with and without AKI. Although there were no significant differences in long-term kidney function between groups, long-term mortality was worse in the AKI group (p = 0.017). Conclusions: Hypertension, type A aortic dissection, and low platelet levels were risk factors for AKI after aortic dissection, and AKI increased the 1-year all-cause mortality. A large-scale study is needed to verify our results.

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“…Increased preload secondary to AKI-induced salt and water retention 70,71 . To illustrate the association between acute kidney injury and cardiovascular risk, Ko et al revealed that mortality and major adverse cardiovascular and cerebrovascular events significantly correlated with the severity of AKI, and the severity of AKI influences strongly patient outcomes, so it has to be recognized immediately and treated aggressively when possible 72 . Furthermore, the association between AKI and subsequent risk for cardiovascular disorder were identified in other studies 73,74 .…”

Section: Remote Organ Injury Following Renal I/r Injurymentioning

confidence: 99%

Most Important Cellular Changes Involved in Renal Ischemia Reperfusion Injury and the Consequent Impact on Selected Remote Organs

Khalifa

Ghoneim²

2018

UJPR

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Because of the high rate of baseline oxygen use by renal cells, kidney is highly influenced by obstruction of arterial blood inflow and subsequent shortage of the received oxygen, this condition is known as Ischemic injury. There are many clinical settings associated with unavoidable ischemic state such as kidney transplantation, partial nephrectomy or suprarenal procedures of the aorta. During ischemia many cellular changes occur including vascular congestion and adhesion of inflammatory cells to the endothelium with subsequent infiltration into the kidney tissue. Following ischemia, a phase known as Reperfusion begins and involves a return of blood and oxygen supply to micro vessels. Reperfusion was expected to restore the damage occurred during the ischemic phase, paradoxically, reperfusion leads to more congestion, red cells trapping and excessive generation of reactive oxygen species (ROS), which can oxidatively modify significantly every type of biomolecule, thereby inducing cell dysfunction and induce reperfusion injury. Ischemia reperfusion injury (IRI) is also related to a phenomenon called Remote Organ Injury (ROI) in which the damaging effect induced by I/R is not only restricted to the tissue that undergoing the initial ischemia but also it leads to injury to remote organs such as the liver, lung, gut. ROI usually occurs by the same mechanisms seen in the local injury induced by I/R including the generation of ROS, leukocytes, and inflammatory mediators (e.g; TNF-α). These substances are directly released from the primary injured tissue or indirectly from activated leukocytes or other inflammatory cells causing organ dysfunctions in distant organs.

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Impact of Acute Kidney Injury on Early to Long-Term Outcomes in Patients Who Underwent Surgery for Type A Acute Aortic Dissection

Cited by 108 publications

References 21 publications

Intervention Associated Acute Kidney Injury and Long-Term Cardiovascular Outcomes

Intervention Associated Acute Kidney Injury and Long-Term Cardiovascular Outcomes

Risk factors for acute kidney injury after initial acute aortic dissection and their effect on long-term mortality

Most Important Cellular Changes Involved in Renal Ischemia Reperfusion Injury and the Consequent Impact on Selected Remote Organs

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