Objective To analyze the risk factors of continuous renal replacement therapy (CRRT) in patients with acute Standford type A aortic dissection (ATAAD) after emergency surgery for hybrid aortic arch debranching and construct a predictive model. Methods Retrospective analysis was performed on 354 patients with ATAAD who underwent emergency surgery for hybrid aortic arch debranching. According to whether CRRT was performed after surgery, the patients were divided into two groups: a CRRT group (n=40) and a non‑CRRT group (n=314). Their general information, medical history, preoperative laboratory examination, preoperative pericardial effusion, renal artery involvement in aortic dissection, intraoperative data, intraoperative blood product infusion, and serum creatinine level on postoperative day 7 were collected. Univariate and multivariate regression analyses were conducted on preoperative and intraoperative variables, in order to identify the independent risk factors for postoperative CRRT in ATAAD patients. Then, a nomogram was established. The Bootstrap method was used for internal validation. The concordance index (C‑index), calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, consistency, and clinical practicability of the model, respectively. A receiver operating characteristic (ROC) curve was plotted and the area under curve (AUC) was calculated. Results Among 354 patients with ATAAD, 40 (11.3%) underwent CRRT after surgery. Compared with the CRRT group, the non‑CRRT group showed decreases in the proportions of renal disease history, preoperative pericardial effusion and renal artery involvement in aortic dissection (all P<0.05), reductions in the levels of high‑sensitivity troponin T, N‑terminal B‑type natriuretic peptide, creatine kinase isoenzyme, myoglobin, serum creatinine and blood urea nitrogen (all P<0.05), increases in the platelet count (P<0.05), decreases in the prothrombin time and D‑dimer (both P<0.05), decrease in the lactic acid level before and after cardiopulmonary bypass (both P<0.05), reduction in the operation time (P<0.05), and decreases in the percentage of intraoperative platelet transfusion >1 therapeutic dose (P<0.05). There was no statistical difference in other indicators between the two groups (all P>0.05). Preoperative myoglobin [odds ratio (OR) 1.001 (95% confidence interval (CI) 1.001, 1.002)], preoperative serum creatinine [OR 1.016 (95%CI 1.010, 1.023)], preoperative pericardial effusion [OR 5.658 (95%CI 2.322, 13.787)], lactic acid at the end of surgery [OR 1.241 (95%CI 1.075, 1.371)], intraoperative platelet transfusion >1 therapeutic dose [OR 9.876 (95%CI 1.811, 53.863)] was independent risk factors for CRRT in ATAAD patients after hybrid aortic arch debranching (P<0.05). The C‑index of this model was 0.891 (95%CI 0.845, 0.937). The predicted results in the calibration curve correlated well with the actual results, with a mean absolute error of 0.027. The AUC of the ROC curve was 0.891 (95%CI 0.845, 0.937) and the model demonstrated good discrimination and consistency. DCA analysis showed that the model had good clinical utility when the probability threshold was 4%−67%. Conclusions Preoperative myoglobin, preoperative serum creatinine, preoperative pericardial effusion, lactic acid level at the end of surgery and intraoperative platelet transfusion >1 therapeutic dose are independent risk factors for CRRT in ATAAD patients after emergency surgery for hybrid aortic arch debranching and the established nomogram has good predictive efficiency.