Acute kidney injury following total joint arthroplasty: retrospective analysis

Abstract

Introduction Postoperative acute kidney injury (AKI) following arthroplasty has not been well studied. Our aim was to identify factors associated with increased risk of AKI. Methods The medical records for adult patients who underwent elective total joint arthroplasty during June 1, 2007 to May 31, 2010 at the Mayo Clinic were reviewed to identify patients with normal preoperative kidney function who experienced perioperative AKI, defined as an increase in serum creatinine (sCr) by 26.4 lmolÁL -1 . For each AKI case, two controls were identified and matched for age, sex, and type of operation. Medical records were abstracted for demographics, comorbid conditions, and preoperative, intraoperative, and postoperative variables. Conditional logistic regression analyses were performed to identify risk factors for AKI. Results Of the 9,171 patients who underwent joint replacement operations, 167 with normal preoperative renal function developed AKI with a median [25 th , 75 th ] increase in sCr of 35.4 [26.4, 44.2] lmolÁL -1 . No patient required dialysis. A higher than normal body mass index, diabetes mellitus, the number of baseline antihypertensive medications, cerebral or peripheral vascular disease, use of general anesthesia, and perioperative blood transfusions were independently associated with risk for AKI. Hospital length of stay and intensive care admissions were greater in AKI patients, and in 12.0% of patients, sCr remained at least 26.4 lmolÁL -1 higher than preoperative baseline at least three months after surgery. Conclusion In this case-control investigation, we identified several factors associated with the development of postoperative AKI. Recognition of these risk factors could allow for the adoption of perioperative renal protective strategies in patients undergoing arthroplasty.

Acute kidney injury following primary hip and knee arthroplasty surgery

“…Univariate analysis of a number of previously reported preoperative risk factors 10,11 for AKI ( (Table 4) identified that age (in decades) and the requirement for more than a litre of postoperative fluids were significant predictors of postoperative AKI. Every extra decade in age increased the odds ratio of postoperative AKI by 1.62.…”

“…A number of case-controlled [10][11][12][13][14][15][16] and observational cohort studies [17][18][19] have previously examined risk factors for AKI following arthroplasty surgery. These include older age, 17 male sex, 18 higher body mass index, [10][11][12]19 increased weight, 13 preoperative renal impairment, 10,17 chronic obstructive pulmonary disease, 10 A variety of treatment related factors have been identified as being associated with AKI.…”

“…These include older age, 17 male sex, 18 higher body mass index, [10][11][12]19 increased weight, 13 preoperative renal impairment, 10,17 chronic obstructive pulmonary disease, 10 A variety of treatment related factors have been identified as being associated with AKI. Antimicrobial stewardship guidance led many departments to move away from cephalosporins because of the increased risk of Clostridium difficile infection.…”

Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib

“…Weingarten et al of the Acute Kidney Injury Network (AKIN) staging system (8,9) . Similarly, we did not evaluate decline in urine output perioperatively secondary to inaccuracies of such …”

“…In the elective arthroplasty setting there have been only a handful of studies aimed at determining what patient risk factors contribute to renal injury and impairment which have identified a relatively low risk of acute kidney injury ranging from 0.55-1.8% (7,8) .…”