Postoperative AKI occurs in half of type A aortic dissection surgeries, meta-analysis findsFactors Linked to Kidney Injury After Aortic Dissection Surgery

Frontiers in Medicine Published June 15, 2026 DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider that half of TAAD surgery patients develop AKI; assess and mitigate risk factors perioperatively.

This meta-analysis of 44 studies involving 11,983 patients undergoing surgery for Stanford type A aortic dissection (TAAD) reports that the overall incidence of postoperative acute kidney injury (AKI) is 50.72%, with 6,115 patients developing AKI. The analysis identified several risk factors associated with increased odds of AKI: age (per 1-year: OR 1.03; per 10-year: OR 1.40), male gender (OR 1.72), BMI (OR 1.13), history of hypertension (OR 1.59), preoperative serum creatinine (OR 1.02), preoperative leukocyte count (OR 1.04), preoperative lactate (OR 1.28), renal artery involvement (OR 3.47), cardiopulmonary bypass time (per 1-minute increase: OR 1.01), operative time (OR 1.33), deep hypothermic circulatory arrest time (OR 1.07), red blood cell transfusion volume (OR 1.18), and duration of mechanical ventilation (OR 1.01). The authors note that these are associations, not causal relationships. Limitations of the meta-analysis were not reported. The high incidence of AKI suggests the need for a comprehensive prevention and control system including preoperative assessment, intraoperative protection, and postoperative monitoring. Clinicians should be aware of the substantial risk of AKI in this population and consider targeted risk factor modification where possible.

How this fits prior evidence

This meta-analysis extends prior findings on acute aortic dissection by quantifying the high incidence of postoperative AKI (50.72%) and identifying multiple risk factors. It complements the earlier report that high neutrophil-to-albumin ratio associates with increased 30-day mortality in acute aortic dissection, as both highlight prognostic markers in this condition. The risk factors identified here, such as hypertension and renal artery involvement, align with known clinical predictors. The study does not address mechanistic pathways like VSMC-immune interactions or diagnostic tools such as deep learning models.

A large review of 44 studies involving nearly 12,000 patients looked at the risk of acute kidney injury (AKI) following surgery for Stanford type A aortic dissection. The study found that approximately 50.72% of these patients developed some form of kidney injury after their procedure.

Researchers identified several factors associated with a higher risk of kidney issues. These included being male, having a history of high blood pressure, and having a higher body mass index (BMI). Certain medical measurements before surgery, such as elevated lactate levels or higher creatinine levels, were also linked to increased risk. During the operation, longer times for cardiopulmonary bypass or mechanical ventilation were associated with more kidney issues.

Because many patients face these risks, the findings suggest that doctors may need better systems to monitor and protect kidneys before and after surgery. While these factors are linked to higher risk, they do not prove that one specific factor causes the injury. Patients should discuss their specific risk factors and potential monitoring plans with their surgical team.

What this means for you:

Over half of patients undergoing this aortic surgery face kidney risks linked to age, gender, and procedure length.

Common questions

How common is kidney damage after this type of heart surgery?

The study found that 50.72% of patients who underwent surgery for Stanford type A aortic dissection developed acute kidney injury. This means more than half of the patients in the study experienced some level of kidney issues following their procedure.

What specific factors increase the risk of kidney problems?

Several factors were linked to a higher risk of kidney injury, including being male (OR 1.72), having hypertension (OR 1.59), and having a higher BMI (OR 1.13). Surgical factors like longer cardiopulmonary bypass times and longer mechanical ventilation also showed links to increased risk.

Do these findings mean the surgery is unsafe for certain people?

The study identifies associations between certain conditions, such as age or high blood pressure, and an increased risk of kidney injury. However, it does not prove that one factor causes the injury. Patients should talk to their doctors about how these risks apply to their specific health situation.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

BackgroundThis study aims to synthesize the existing evidence to identify the incidence of AKI following surgery for TAAD and its primary risk factors.MethodsSystematically searched PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang, VIP, and the China Biomedical Literature Database to identify studies published from the inception of each database through January 6, 2026, regarding the incidence and risk factors of postoperative AKI following TAAD. Two researchers independently screened the literature and extracted data, and the Newcastle-Ottawa Scale (NOS) was used to assess study quality. Meta-analysis was performed using Stata 15.0 software.ResultsA total of 44 studies were included, with a total sample size of 11,983 patients, of whom 6,115 developed AKI. The meta-analysis showed that the overall incidence of postoperative AKI following TAAD was 50.72%. Subgroup analysis showed that the incidence rate was higher when diagnosed using the KDIGO criteria compared to the AKIN and RIFLE criteria; the incidence rate in Chinese studies was higher than that in non-Chinese studies. Regarding risk factors, age (per 1-year: OR = 1.03; per 10-year: OR = 1.40), male (OR = 1.72), BMI (OR = 1.13), history of hypertension (OR = 1.59), preoperative serum creatinine (OR = 1.02), preoperative leukocyte count (OR = 1.04), preoperative lactate (OR = 1.28), renal artery involvement (OR = 3.47), cardiopulmonary bypass time (per 1-minute increase: OR = 1.01), operative time (OR = 1.33), deep hypothermic circulatory arrest time (OR = 1.07), red blood cell transfusion volume (OR = 1.18), and duration of mechanical ventilation (OR = 1.01) may be significantly associated with postoperative AKI following TAAD.ConclusionThe incidence of AKI following TAAD is high, with major risk factors including advanced age, male gender, high BMI, hypertension, elevated preoperative serum creatinine and white blood cell count, renal artery involvement, prolonged cardiopulmonary bypass and deep hypothermic circulatory arrest, increased perioperative blood transfusion, and prolonged mechanical ventilation. Clinically, a comprehensive prevention and control system covering preoperative assessment, intraoperative protection, and postoperative monitoring should be established to reduce the incidence of AKI and improve patient outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, PROSPERO CRD420261276938.

Postoperative AKI occurs in half of type A aortic dissection surgeries, meta-analysis findsFactors Linked to Kidney Injury After Aortic Dissection Surgery

How this fits prior evidence

Common questions

Study Details

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