Acute kidney injury following primary hip and knee arthroplasty surgery

Abstract

Acute kidney injury (AKI) is a recognised postoperative complication following primary hip/knee arthroplasty surgery. The aim of this study was to determine causative and potentially modifiable risk factors associated with postoperative AKI. Standard data were collected for 413 consecutive arthroplasty patients, both retrospectively and prospectively. Univariate and multivariate analyses were performed to identify any potential causative factors. Eight percent of patients developed postoperative AKI. Univariate analysis found increasing age, history of previous chronic kidney disease and requirement for postoperative intravenous fluids to be risk factors for AKI. The multivariate regression analysis model identified age and volume of postoperative fluid prescription as predictive of postoperative AKI. Antibiotic regime and prescription of non-steroidal anti-inflammatory drugs had no significant effect on the risk of AKI. No patients required dialysis but length of stay increased by 50% in the AKI group. Postoperative AKI may result in significant postoperative morbidity and increased length of stay, and may necessitate invasive therapies such as dialysis. Episodes of AKI could also predispose to future similar episodes and are associated with a long-term decrease in baseline renal function. This study has demonstrated that the identified risk factors are generally non-modifiable. Further work is suggested to determine whether targeted interventions in high risk patients would reduce the incidence of AKI.

Chronic kidney disease and acute kidney injury in arthroplasty patients over 65 years of age

“…In this study, of those subjects who had their postoperative sCr measured, 2.9% fulfilled the AKI criteria. This is in agreement with previous reports, where the incidence of AKI varies between 2% and 15% among patients undergoing lower limb arthroplasty …”

“…The most common indications for these operations are osteoarthosis, rheumatoid arthritis and traumatic fractures . Several previous studies have examined the risk factors for AKI and reported its incidence to vary between 2% and 15% among patients undergoing lower limb arthroplasty . In these studies, no age‐related exclusion criteria were used, only elective arthroplasties were examined, or only patients with normal preoperative kidney function were included …”

Acute kidney injury after hip or knee replacement: Can we lower the risk?

“…Dubrovskaya et al 20 and Ferguson et al, 26 in contrast, found no increased risk with addition of gentamicin.…”

“…Multiple studies assessed the risk of acute kidney injury comparing regimens containing an aminoglycoside (typically gentamicin) with regimens lacking these agents. [20][21][22][23][24][25][26] In general, these studies found a signifi cantly higher risk of acute kidney injury when gentamicin was used.…”

“…Older age is often signifi cant in studies assessing primary total joint arthroplasty or revision Acute kidney injury may complicate up to 10% of primary total knee or hip replacements FILIPPONE AND YADAV total joint arthroplasty not specifi cally for infection. 11,12,16,17,26,28 Obesity is also a major factor in the development of acute kidney injury, 7,[10][11][12]17,18 and, along with age, is a major factor contributing to the need for joint replacement in the fi rst place.…”