['Preoperative chronic kidney disease (CKD) has been shown to predict postoperative renal complications and mortality after open aortic surgery; the impact of postoperative renal complications less severe than permanent dialysis are unknown. We evaluated the impact of postoperative renal dysfunction severity on survival using a regional quality improvement registry.', 'Patients undergoing intact open aortic reconstruction in the Vascular Study Group of New England registry (2003-2012) were stratified by severity of postoperative renal complications; none, creatinine increase of greater than 0.5 mg/dL (incCr), or any hemodialysis (HD). Predictors of renal dysfunction and impact of renal complications on survival were analyzed using multivariable methods.', 'We included 2695 patients, of which 65% (n = 1733) underwent open abdominal aortic aneurysm repair, and 35% (n = 962) open aortoiliac reconstruction. At baseline, 15% of patients had preoperative moderate CKD and 1.2% had severe CKD. Postoperative renal complications of incCr occurred in 8.5% of patients, and 1.5% required HD. Multivariable cumlogit regression identified severe baseline CKD (odds ratio [OR], 15; 95% confidence interval [CI], 6.4-34; P < .001, moderate CKD (OR, 2.8; 95% CI, 1.9-3.3; P < .001), suprarenal clamp use (OR, 2.2; 95% CI, 1.6-2.9; P < .001), perioperative vasopressor requirements (OR, 2.2; 95% CI, 1.6-2.9; P < .001), operating time (OR, 1.004 per minute; 95% CI, 1.003-1.006; P < .001), and chronic obstructive pulmonary disease (OR, 1.5; 95% CI, 1.2-1.8; P < .001) as independent predictors of worsening strata of postoperative renal dysfunction. Multivariable logistic regression analysis showed that patient age (OR, 1.06 per year; 95% CI, 1.01-1.1; P = .01), baseline chronic obstructive pulmonary disease (OR, 1.6; 95% CI, 1.2-2.2; P < .01), incCr (OR, 3.7; 95% CI, 1.8-7.4; P = .009), and HD (OR, 4.8; 95% CI, 1.8-12.7); P = .009) independently increased 30-day mortality. Risk-adjusted multivariable Cox regression showed that incCr (hazard ratio, 1.8; 95% CI, 1.3-2.6; P < .001) and HD (hazard ratio, 4.4; 95% CI, 2.8-6.9; P < .001) increased risk of late death independent of a variety of other clinical variables, including baseline CKD. The 5-year survival was lower (log-rank P < .001) in patients with incCr (66% ± 4%), and HD (38% ± 10%) compared with those with no renal complications (77% ± 1%).'] Does postoperative renal dysfunction independently predict late mortality in patients undergoing aortic reconstruction?