Early postoperative albumin level following total knee arthroplasty is associated with acute kidney injury

Abstract

Hypoalbuminemia has been reported to be an independent risk factor for acute kidney injury (AKI). However, little is known about the relationship between the albumin level and the incidence of AKI in patients undergoing total knee arthroplasty (TKA). The aim of our study was to assess incidence and risk factors for AKI and to evaluate the relationship between albumin level and AKI following TKA.The study included a retrospective review of medical records of 1309 consecutive patients who underwent TKA between January 2008 and December 2014. The patients were divided into 2 groups according to the lowest serum albumin level within 2 postoperative days (POD2_alb level < 3.0 g/dL vs ≥3.0 g/dL). Multivariate logistic regression analysis was used to assess risk factors for AKI. A comparison of incidence of AKI, hospital stay, and overall mortality in the 2 groups was performed using propensity score analysis.Of 1309 patients, 57 (4.4%) developed AKI based on Kidney Disease Improving Global Outcomes criteria. Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01–1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65–5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26–1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48–4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08–87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09–3.37; P = 0.023). After propensity score analysis, POD2_alb level<3.0 g/dL was associated with AKI occurrence (OR 1.82; 95% CI 1.03–3.24, P = 0.041) and longer hospital stay (P = 0.001).In this study, we demonstrated that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and lengthened hospital stay in patients undergoing TKA.

Preoperative hypoalbuminemia was associated with acute kidney injury in high-risk patients following non-cardiac surgery: a retrospective cohort study

“…Kim et al [15] conducted a retrospective study enrolling 4718 patients who underwent partial or total gastrectomy for gastric cancer, and they revealed that patients with preoperative hypoalbuminemia, defined as <40 g/L, had a significantly increased risk for AKI (OR 1.4; 95% CI 1.11-1.77). In patients following hip fracture surgery or total knee arthroplasty, after adjustment for confounders, early postoperative hypoalbuminemia has been shown to be strongly associated with AKI with a cutoff value of <29 g/L and <30 g/L [16,17] [18]. The finding from our study that preoperative hypoalbuminemia had a significant relationship with postoperative AKI was consistent with the results above.…”

“…Therefore, we assumed that preoperative hypoalbuminemia might be associated with an increased risk of AKI following non-cardiac surgery. However, limited data are currently available on this topic [15][16][17][18]. Thus, this study aimed to investigate the association between preoperative serum albumin concentration and AKI occurrence in high-risk patients following non-cardiac surgery.…”

Predictive factors for effectiveness and safety of enoxaparin for total knee arthroplasty in aged Japanese patients: a retrospective review

“…Based on this fact and our findings, it appears that the pharmacology and ADE of enoxaparin might be enhanced by hypoproteinemia. Additionally, hypoalbuminemia is a major complication after surgery, including TKA [25–27]. Kumar et al [28] reported that hypoproteinemia is a risk factor for DVT.…”

Are There Modifiable Risk Factors to Improve AKI?

“…The biomarkers of inflammation, including C-reactive protein (CRP), eosinophil count, and white blood cell count, indicate the degree of inflammation, which can be adjusted for in multivariate analyses. Lee et al [50, 51] adjusted for C-reactive protein (CRP) and the result showed that preoperative albumin levels were associated with AKI, the same result as in studies that have not adjusted for CRP [52–55]. Thus, evidence suggests that hypoalbuminemia is a significant independent predictor of both AKI and death following AKI.…”

“…In human clinical evidence, hypoalbuminemia has been reported to be independently associated with an increased risk of AKI in various surgical and other situations [50–55]. A meta-analysis also evaluated the influence of serum albumin levels on the incidence of AKI and mortality in patients with AKI [56].…”