Risk Factors for Acute Kidney Injury after Stanford Type A Aortic Dissection Repair Surgery: a Systematic Review and Meta-Analysis

Background Acute kidney injury (AKI) is one of the most common complications after Stanford type A aortic dissection (TAAD) repair surgery, but its risk factors are inconsistent in different studies. So this meta-analysis was conducted to systematically analyze the risk factors for AKI after TAAD repair surgery, so as to early identify the therapeutic targets for preventing AKI and to improve the outcomes. Methods Studies on risk factors for AKI after TAAD repair surgery were searched from PubMed, Embase, Cochrane library and Web of science from inception of databases to June 2021. The meta-analysis was performed by Stata 16.0 software. The combined incidence and risk factors of AKI and its impact on mortality after TAAD repair surgery were calculated. Results A total of 11 studies and 4156 patients were included. The combined incidence of postoperative AKI was 56.0%. The advanced age [odds ratio (OR)=1.32, 95% confidence interval (CI) (1.19, 1.47), P <0.001], cardiopulmonary bypass time > 180 minutes [OR=4.88, 95% CI (2.05, 11.59), P <0.001], red blood cell (RBC) volume transfused perioperatively [OR=1.13, 95% CI (1.03, 1.24), P <0.01], high body mass index [OR=1.22, 95% CI (1.18, 1.27), P <0.001] and preoperative renal malperfusion [OR= 5.32, 95% CI (2.92, 9.71), P <0.001] were risk factors for AKI after TAAD repair surgery. The in-hospital mortality [rate ratio (RR)=2.50, 95% CI (1.82, 3.44), P <0.001] and 30-day mortality [RR=2.81, 95% CI (1.95, 4.06), P <0.001] were higher in patients with postoperative AKI than that without AKI. Conclusions The incidence of AKI after TAAD repair surgery was high, and it increased the in-hospital and 30-day mortality. Reducing cardiopulmonary bypass time and RBC transfusions perioperatively, especially in elderly or patients with high body mass index, or patients with renal malperfusion preoperatively were important to prevent AKI after TAAD repair surgery. Systematic review registration number: INPLASY 202060100.