Factors for Acute Kidney Injury Following Total Arch Replacement and Association with Temperature Management During Cardiopulmonary Bypass: A Single-center Retrospective Observational Study

Many patients develop acute kidney injury (AKI) after vascular surgery. In this retrospective observational study, we investigated the risk factors for AKI defined using the Kidney Disease Improving Global Outcomes criteria after total arch replacement (TAR). Additionally, we investigated the influence of temperature management during cardiopulmonary bypass (CPB) on postoperative renal function by propensity score-matched analysis. We retrospectively analyzed 161 consecutive patients who underwent TAR between 2016 and 2019. Postoperative AKI occurred in 48.7% of the patients. In the multivariate analysis, male sex (odds ratio [OR] 3.95, 95% confidence interval [95%CI] 1.56–8.27, p = 0.002), ACE inhibitors/ARB medication (OR 3.19, 95%CI 1.49–6.82, p = 0.003), preoperative chronic kidney disease (OR 2.47, 95%CI 1.17–5.23, p = 0.02), prolonged CPB time (OR 2.36, 95%CI 1.05–5.34, p = 0.04), and lower body ischemic time during CPB (OR 2.20, 95%CI 1.05–4.46, p = 0.04) were identified as independent risk factors for AKI. Propensity score-matched analysis showed no significant difference in the risk of AKI following TAR between mild hypothermia or normo-thermia and moderate hypothermia (37.2% vs. 41.9%, p = 0.83). In conclusion, modifiable risk factors for AKI included prolonged CPB time and lower body ischemic time. Temperature management during CPB had no clear effect on outcomes.