Greater Rates of Acute Kidney Injury in African American Total Knee Arthroplasty Patients

Abstract

Background: This retrospective study compared the change in serum creatinine between African American and Caucasian Total Knee Arthroplasty (TKA) patients. The authors hypothesized that African Americans would demonstrate significantly greater change, and that a significantly greater proportion would demonstrate creatinine changes consistent with acute kidney injury (AKI). Methods: Primary TKAs performed at a single institution between July, 2011-June, 2016 were identified: 1035 primary TKAs met inclusion and exclusion criteria (110 African American, 925 Caucasian, excluding Hispanic and Asian patients). None were excluded based on sex, age, BMI, preoperative diagnosis or comorbidities. All patients had pre-operative and post-operative creatinine levels available in the EMR. Each patient received the same pre-op and post-op protocol for NSAID use along with other drugs administered including anesthesia. All patients received 1 gram of IV (intravenous) vancomycin with some patients additionally receiving 1 gram of vancomycin powder administered locally at the end of surgery. All patients were controlled for fluid intake and blood loss, along with no patient receiving a transfusion or IV contrast. Patient demographics and pre/postoperative serum creatinine were recorded then analyzed for presence of AKI (≥0.3mg/dL). Pre/postoperative serum creatinine concentrations were compared between African American and Caucasian patients using 2×2 repeated measures ANOVA. Prevalence of patients in each group demonstrating AKI was calculated using Fisher Exact test. Results: African American patients had significantly greater serum creatinine preoperatively (1.00±0.26 vs. 0.90±0.22, p<0.001) and a significantly greater increase postoperatively (0.10 vs. 0.03, p<0.001). A significantly greater number of African American patients demonstrated AKI (10.9% vs. 5.1%, p=0.03). Furthermore, a significantly greater number of African American patients stayed in the hospital an additional 2 or more days for renal issues (2.7% vs. 0.4%, p=0.03).

Postoperative Acute Kidney Injury With Dual NSAID Use After Outpatient Primary Total Joint Arthroplasty

“…Perioperative and postoperative risk factors include general anesthesia, hypovolemia, hypotension, and use of nephrotoxic medications. 16,17 CKD is a possible sequela of AKI, which can lead to hospitalization and increased mortality. 15,18 NSAIDs have a proven role in improving postoperative pain control and decreasing the opioid burden after primary total hip and total knee arthroplasties.…”

“…Perioperative and postoperative risk factors include general anesthesia, hypovolemia, hypotension, and use of nephrotoxic medications. 16,17 CKD is a possible sequela of AKI, which can lead to hospitalization and increased mortality. 15,18…”

The Effects of Race on Acute Kidney Injury

“…Similarly, other studies have reported significantly higher incidence of AKI along racial lines among specialized populations, including patients with diabetes [ 17 ], trauma [ 20 ], and those undergoing procedures such as percutaneous coronary intervention [ 8 , 21 ] and knee surgery [ 19 ].…”

“…Previous studies have reported that Black patients have a disproportionately higher risk of AKI when compared with White patients [ 4 , 8 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Using self-reported Black and White participants from the Atherosclerosis Risk in Communities (ARIC) study, Grams et al [ 4 ] investigated the impact of race on the incidence of AKI-related hospitalizations.…”

Vancomycin Associated Acute Kidney Injury: A Longitudinal Study in China

“…However, due to variations in study populations and sample sizes, different studies have identified conflicting risk factors. Several studies have shown that specific races (e.g., African-Americans) have a higher risk for VA-AKI ( Bosso et al, 2011 ; Womble et al, 2019 ); although, studies specifically investigating Asian populations are lacking. For patients developed VA-AKI, how to reduce mortality and improve renal recovery is still a difficult problem to be explored.…”