title: Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair.
abstract: BACKGROUND
  Although acute kidney injury (AKI) is known as a serious complication after operation for acute type A aortic dissection (AAAD), the long-term impact of AKI remains unclear. The aim of the present study is to investigate the long-term survival in patients with AKI after operation for AAAD.
  
  
  METHODS
  This study included 403 patients who underwent operation for AAAD from 1990 to 2011 at Jichi Medical University, Saitama Medical Center. Postoperative AKI was identified according to the Kidney Disease Improving Global Outcomes criteria. Kaplan-Meier survival analysis and Cox proportional hazards regression were modeled to analyze the association between the AKI stage and postoperative long-term survival.
  
  
  RESULTS
  Of 403 patients, 181 (44.9%) experienced postoperative AKI. Kaplan-Meier estimates for long-term survival were significantly different among patients without AKI and patients with stage 1, 2, and 3 AKI (p < 0.001). Hazard ratios of long-term survival for patients with stages 1, 2, and 3 AKI compared with patients without AKI were 1.38 (95% confidence interval [CI]: 0.84 to 2.26), 1.82 (95% CI: 0.95 to 3.51), and 3.79 (95% CI: 1.95 to 7.37), respectively. More patients with AKI died because of cardiovascular disease after discharge than patients without AKI (1.8% versus 6.0%, p = 0.03).
  
  
  CONCLUSIONS
  Stage 3 AKI is significantly associated with lower long-term survival after operation for AAAD. Patient follow-up after discharge that focuses on cardiovascular issues may benefit patients who survive AKI after AAAD operation.
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan. Electronic address: sasabuchi-tky@umin.ac.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sasabuchi
authors.affiliation: Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kimura
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Shiotsuka
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Komuro
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Mouri
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Ohnuma
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Asaka
authors.affiliation: Department of Surgery, Jichi Medical University, Tochigi, Japan.
authors.forename: Alan K
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.affiliation: Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Sanui
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality*; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors