Chronic kidney disease is associated with a risk of higher mortality following total knee arthroplasty in diabetic patients: a nationwide population-based study

Abstract

Diabetes and chronic kidney disease (CKD) are associated with a higher rate of complications in patients undergoing total knee arthroplasty (TKA). The purpose of this study was to determine the effects of CKD and diabetes in patients after TKA. Diabetic patients who received unilateral primary TKA between January 2008 and December 2011 were enrolled. The follow-up period was more than 6 months. The primary outcome was a TKA-related infection and the secondary outcome was all-cause mortality. The study cohort included 13844 patients who were followed for a mean period of 2 years, of whom 1459 (10.5%) had CKD. The patients with CKD were older than those without CKD (71.6 versus 70.3 years, P<0.0001) and had higher rates of hypertension, gouty arthritis, ischemic heart disease, chronic pulmonary obstructive disease, pulmonary embolism and deep vein thrombosis (all P<0.0001). After adjustment of comorbidities, the CKD group had a higher incidence of urinary tract infections (OR: 1.61, 95% CI: 1.19-2.17). There were no significant differences in wound infections, pneumonia, pulmonary embolism or in-hospital death between the two groups. After adjustment of confounders, the CKD group had higher rates of myocardial infarction (HR: 2.06, 95% CI: 1.26–3.39) and mortality (HR: 1.99, 95% CI: 1.59–2.48). The risk of TKA-related infection during follow-up was comparable between the two groups (HR: 1.31, 95% CI: 0.94–1.82). In conclusion, CKD is associated with increased risks of urinary tract infections, myocardial infarction and all-cause mortality after TKA. Surgeons should be aware of this when evaluating TKA patients with renal disease.

Chronic Kidney Disease Worsens Health Outcomes in Diabetic Patients After Hip Fracture Surgery: An Asian Nationwide Population-Based Cohort Study

“…These patients were then classified into three groups according to renal functional status: those with no CKD (non‐CKD group), those with CKD (CKD group), and those receiving dialysis (dialysis group). CKD was defined according to the ICD‐9‐CM diagnostic codes validated in previous studies, as given in Supplementary Table S1 . Under the regulation of the Taiwan NHI, the diagnosis of CKD was based on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF‐K/DOQI) guidelines: (1) the appearance of indicators of kidney damage in the urine or blood, and (2) estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 .…”

“…Surgery‐related infections were defined as all instances of superficial wound infection or deep infection during the follow‐up period. Concerning the subtype of infection, superficial wound infection was defined as readmission based on an infection requiring only antibiotic treatment; deep infection included readmission for simple debridement and surgical debridement with implant removal …”

“…CKD was defined according to the ICD-9-CM diagnostic codes validated in previous studies, (27,28) as given in Supplementary Table S1. (29) Under the regulation of the Taiwan NHI, the diagnosis of CKD was based on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines: (1) the appearance of indicators of kidney damage in the urine or blood, and (2) estimated glomerular filtration rate (eGFR) <60 mL/min/ 1.73 m 2 . (30,31) Dialysis status was determined by the presence of a catastrophic illness certificate (CIC) in the NHIRD, required for reimbursement for all dialysis fees for those with permanent dialysis.…”

“…Concerning the subtype of infection, superficial wound infection was defined as readmission based on an infection requiring only antibiotic treatment; deep infection included readmission for simple debridement and surgical debridement with implant removal. (29) We defined revision surgery as any of the following: (1) revision osteosynthesis, or (2) revision to hemiarthroplasty or total hip arthroplasty. We further divided revision into aseptic and septic revision by whether there was a record of any surgery-related infections in the 6 months before the revision surgery.…”

Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis

“…Several studies reported correlation between CKD and TJA outcomes. Reports from earlier studies vary with regard to the effect of CKD on the risk of complications, such as mortality, PJI, and arthroplasty revision rate [15,[21][22][23][24][25][26]. However, no systematic review or meta-analysis of this relationship was conducted.…”