Early-stage Acute Kidney Injury Adversely Affects Thoracoabdominal Aortic Aneurysm Repair Outcomes

Abstract Background Acute kidney injury (AKI) necessitating renal replacement therapy adversely affects outcomes after thoracoabdominal aortic aneurysm (TAAA) repair. The effects of earlier stages of AKI are less known. We hypothesized that earlier stages of AKI would reduce early survival after TAAA repair. Methods We analyzed prospectively collected data from 1056 consecutive TAAA repairs from our institution (2006-2016). We excluded patients Results Of 873 patients, 642 (73.5%) had no AKI and 231 (26.5%) had postoperative AKI (mild/stage 1, n=92 [10.5%]; moderate/stage 2, n=44 [5.0%]; severe/stage 3, n=95 [10.9%]). Operative death occurred in 65 patients (7.4%): 14 (2.2%) with no AKI, 5 (5.4%) with mild AKI ( p =0.07 vs no AKI), 8 (18.2%) with moderate AKI ( p =0.02 vs mild), and 38 (40.0%) with severe AKI ( p =0.01 vs moderate). In multivariable analysis, moderate AKI independently predicted death (relative risk ratio 9.4, 95% confidence interval 3.4-25.9). Kaplan-Meier 1-year survival was 91.1±1.2% for no AKI, 84.6±3.9% for mild AKI ( p =0.07 vs no AKI), 67.4±7.6% for moderate ( p =0.01 vs mild), and 67.4±7.6% for severe ( p =0.02 vs moderate) AKI. Conclusions Moderate/stage 2 AKI reduced early survival after TAAA repair. Prevention, earlier detection, and optimal medical management of AKI may improve survival.