Abstract No. 441 Renal artery malperfusion after aortic dissection: clinical diagnosis and correlation with acute kidney injury

Abstract

Acute kidney injury (AKI) is a common complication after aortic dissection and is associated with adverse clinical outcomes. Potential mechanisms contributing to AKI after aortic dissection include renal malperfusion or underlying renal dysfunction from comorbidities. While renal malperfusion is the one acutely treatable cause of AKI, the incidence of AKI in patients with renal malperfusion and the clinical ability of physicians to identify renal malperfusion is unknown. 473 patients without prior dialysis requirement (mean age 58.0 years, 75.7% male) presented with aortic dissection and suspected arterial malperfusion of the intestines, kidneys, or lower extremities (1995 – 2018). These patients underwent a total of 526 cases of aortic catheterization with manometric measurements to identify ongoing arterial malperfusion. Renal malperfusion was suspected based on asymmetric renal enhancement on computed tomography (CT) scan, refractory hypertension, or elevated serum creatinine values. Lower extremity malperfusion was suspected based on peripheral pulse deficit, and elevated lactate levels and abdominal pain indicated possible intestinal malperfusion. AKI was assessed by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. AKI was found in 328 (62.4%) cases at the time of manometric catherization, and renal artery malperfusion was identified in 267 (50.8%) cases. AKI was associated with ongoing renal artery malperfusion in 201 (75.3%) cases compared to 127 (49.0%) cases without renal artery malperfusion (p < 0.001). Renal artery malperfusion was suspected by the clinical care team in 273 cases (51.9%). The sensitivity and specificity of CT and laboratory data to identify ongoing renal artery obstruction were 65.2% and 61.8%, respectively. AKI is common among patients with renal malperfusion. However, clinical suspicion of renal malperfusion is a poor predictor of ongoing renal artery obstruction. Future studies are needed to improve identification of patients with ongoing renal malperfusion.