Risk Factors of Acute Kidney Injury and Its Impact on Three-Year Mortality After Thoracic Endovascular Repair for Type B Aortic Dissection

NA LI^1*Zhiqiang Zhang²Yasong Wang²Tienan Zhou²Xiaozeng Wang^2*

• ¹China, 沈阳市, China
• ²General Hospital of Northern Theatre Command, Shenyang, China

Objective: Acute kidney injury (AKI) following thoracic endovascular aortic repair (TEVAR) significantly impacts outcomes. This study aimed to identify independent predictors of AKI after TEVAR for acute Stanford type B aortic dissection (ATBAD) and evaluate its impact on long-term mortality. Methods: This retrospective analysis included 745 consecutive patients who underwent TEVAR for ATBAD from the General Hospital of Northern Theater Command between February 2004 to November 2022. Acute kidney injury was diagnosed based on serum creatinine increase ≥26.5 μmol/L within 48 hours, ≥1.5-fold increase from baseline within 7 days, or urine output <0.5 mL/kg/hour for 6 hours. Univariate and multivariate logistic regression identified risk factors for AKI and all-cause mortality. Results: AKI occurred in 75 patients (10.1%). Patients developing AKI had higher baseline serum creatinine (85.97 vs 78.30 μmol/L; P=0.009), received more contrast volume (246.13±92.00 vs 221.17±69.92 mL; P=0.042), and had higher prevalence of bilateral renal artery involvement (14.3% vs 5.1%; P=0.020). After a mean follow-up of 36 months, the multivariate analysis identified three independent predictors: bilateral renal artery involvement (odds ratio [OR], 4.381; 95% confidence interval [CI], 1.54-12.45; P=0.006), serum creatinine >114 μmol/L (OR, 2.86; 95% CI, 1.38-5.93; P=0.005), and contrast volume >290 mL (OR, 2.36; 95% CI, 1.10-5.09; P=0.028). All-cause mortality was significantly higher in the AKI group (16.1% vs 4.4%; P<0.001). AKI remained an independent predictor of mortality (OR, 3.02; 95% CI, 1.46-6.28; P=0.003) after adjusting for age, baseline creatinine, and medication use. Conclusions: AKI remains highly prevalent in patients undergoing TEVAR for ATBAD. Bilateral renal artery involvement, elevated baseline creatinine, and contrast volume >290 mL independently predicted AKI. Development of AKI was associated with a three-fold increase in long-term mortality, emphasizing the importance of risk stratification and nephroprotective strategies.