Objective To systematically evaluate the risk factors for postoperative continuous renal replacement therapy (CRRT) in patients with type A aortic dissection. Methods Studies investigating risk factors for CRRT after surgery in patients with type A aortic dissection were retrieved from databases including VIP, Wanfang Medical, China National Knowledge Infrastructure, China Biomedical Literature, China Medical Journal, Web of Science, PubMed, Embase, and Cochrane Library. Meta-analysis of relevant risk factors was performed using RevMan 5.4 software. Results A total of 13 case-control studies involving 6,145 patients were included. Meta-analysis revealed the following risk factors significantly associated with postoperative CRRT: age (MD = 1.90, 95% CI:0.50～3.31,P<0.01),history of chronic kidney disease (OR=4.11,95% CI:2.54～6.65,P<0.01), hepatic dysfunction (OR=2.05, 95% CI:1.52～2.78,P <0.01), preoperative cardiac tamponade (OR=2.48, 95% CI:1.16～5.31,P=0.02), preoperative pericardial effusion (OR =3.20, 95% CI:1.23～8.31,P =0.02), renal artery involvement by dissection (OR =2.42, 95% CI:1.28～4.60,P<0.01), left ventricular end-diastolic diameter (MD=-1.23, 95% CI:-2.21～-0.25,P=0.01),platelet count (MD=-14.28,95% CI:-26.35～-2.21,P=0.02), White blood cell count (MD=1.02,95% CI: 0.44～1.61,P <0.01), blood urea nitrogen (MD=0.85, 95% CI:0.71～1.00,P<0.01), albumin (MD=-1.12, 95% CI:-2.07～-0.18,P=0.02),myoglobin (MD=79.64,95% CI:48.02～105.87,P<0.01), serum creatinine (MD=41.59, 95% CI:27.43～55.75,P<0.01), coronary artery bypass grafting (OR=2.60, 95% CI:1.40～4.82,P<0.01), operative duration (MD=50.66, 95% CI:37.59～63.72,P<0.01), cardiopulmonary bypass time (MD=32.08, 95% CI:22.89～41.27,P<0.01), aortic cross-clamp time (MD=15.31, 95% CI:11.63～18.99,P<0.01), extracorporeal circulation time (MD=27.70, 95% CI:13.81～41.58,P<0.01), intraoperative blood loss (MD =128.03, 95% CI:22.52～233.55,P=0.02), platelet transfusion volume (MD=0.78, 95% CI:0.17～1.39, P=0.01),plasma transfusion volume (MD=176.53, 95% CI:6.78～346.29, P<0.01),red blood cell transfusion volume (MD=3.26, 95% CI:1.63～4.89, P<0.01), mechanical ventilation duration (MD=73.77, 95% CI:19.44～128.09, P<0.01), ICU stay duration (MD=3.81, 95% CI:0.84～6.77, P<0.01), re-exploration for bleeding (OR=4.27, 95% CI:2.75～6.63, P<0.01). Conclusion Risk factors for postoperative CRRT in patients with type A aortic dissection encompass multiple aspects, including general factors, medical history, preoperative status, preoperative laboratory tests, concurrent surgical procedures, intraoperative variables, and postoperative conditions. Clinicians should conduct targeted risk factor screening, identify high-risk patients early, and initiate CRRT appropriately to improve clinical prognosis.
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