Analysis of risk factors for acute kidney injury and in-hospital death following aortic arch surgery based on the RIFLE criteria

The purpose of this study was to identify risk factors for acute kidney injury (AKI) and death of patients undergoing aortic arch surgery based on the RIFLE (risk, injury, failure, loss and end-stage kidney diseases) criteria. AKI was diagnosed according to the RIFLE criteria in patients undergoing aortic arch reconstruction with deep hypothermic circulatory arrest (DHCA). Clinical data of a total of 70 patients undergoing aortic arch reconstruction with DHCA from January 2009 to December 2009 were retrospectively reviewed. Known predictors (age, chronic kidney disease, surgery status, redo, diabetes, hypertension, blood transfusion, bypass, and deep hypothermic circulatory arrest time) were used in multivariate logistic regression analysis for acute kidney injury and in-hospital mortality. Thirty patients (42.9%) were diagnosed as Class I or F according to the RIFLE criteria, among which 10 patients (14.3%) required dialysis. The mortality rate was 11.4%. Risk factors for acute kidney injury included hypertension (odds ratio [OR] = 5.27), postoperative hypoxemia (OR = 13.36) and prolonged vasopressor dependence (OR = 12.49). Risk factors for mortality included AKI (RIFLE class F) (OR = 9.86), post liver dysfunction (OR = 6.42) and prolonged mechanical ventilation (OR = 11.76). AKI is a common complication after aortic arch surgery with DHCA. RIFLE classification provides with a useful diagnostic tool for AKI, and also the chance for further studies on prevention and treatment of AKI after DHCA.   Key words: Deep hypothermic circulatory arrest, aortic arch surgery, risk factors, acute kidney injury.