Predictors of postoperative acute kidney injury in patients undergoing hip fracture surgery: A systematic review and meta-analysis

Zhou, Xinfeng; Zhang, Yijian; Teng, Yun; Chen, Angela Carley; Liu, Tao; Yang, Huilin; He, Fan

doi:10.1016/j.injury.2020.09.060

Cited by 14 publications

(13 citation statements)

References 36 publications

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“…We identified male sex, antihypertensive medications and cardiac/renal comorbidities as risk-factors for acute kidney injury in our cohort. This is largely consistent with previous studies [15]. The majority of riskfactors identified for acute kidney injury and mortality in the current study were either not modifiable or had important interactions (e.g.…”

Section: Discussionsupporting

confidence: 92%

The effect of intra‐operative hypotension on acute kidney injury, postoperative mortality and length of stay following emergency hip fracture surgery

et al. 2021

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The association between intra-operative hypotension and postoperative acute kidney injury, mortality and length of stay has not been comprehensively evaluated in a large single-centre hip fracture population. We analysed electronic anaesthesia records of 1063 patients undergoing unilateral hip fracture surgery, collected from 2015 to 2018. Acute kidney injury, 3-, 30-and 365-day mortality and length of stay were evaluated to assess the relationship between intra-operative hypotension absolute values (≤ 55, 60, 65, 70 and 75 mmHg) and duration of hypotension. The rate of acute kidney injury was 23.7%, mortality at 3-, 30-and 365 days was 3.7%, 8.0% and 25.3%, respectively, and median (IQR [range]) length of stay 8 (6-12 [0-99]) days. Median (IQR [range]) time ≤ MAP 55, 60, 65, 70 and 75 mmHg was 0 (

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Section: Discussionsupporting

confidence: 92%

The effect of intra‐operative hypotension on acute kidney injury, postoperative mortality and length of stay following emergency hip fracture surgery

et al. 2021

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“…When looking into results from the other regression analyses, hypertension was the only variable significantly associated with higher creatinine levels on admission. This result is in line with previous findings 7,24 , suggesting that hypertension is one of the risk factors associated with AKI in non-cardiovascular surgery. Despite not finding a significant association between hypertension and AKI by the KDIGO guidelines criteria, our study showed higher serum creatinine levels on admission among patients with hypertension.…”

Section: Discussionsupporting

confidence: 93%

Factors associated with creatinine increase in older adults with hip fracture

González-Pallares¹,

Montiel-Vázquez²,

Flores-Porras³

et al. 2022

LAGM

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Background: Acute kidney injury (AKI) is a common complication among older adults with hip fracture. Factors such as baseline renal function, comorbidities, the use of nephrotoxic drugs, and age increase the incidence of this complication. Objectives: To find factors related to higher creatinine levels among older adults with hip fracture upon admission, discharge, and during hospitalization in a hospital setting in Mexico. Methods: This was an observational, comparative, longitudinal, and retrospective study. Setting and participants: Data from patients aged 60 and over with hip fracture presenting to the ER from January 2020 to August 2021 with at least one creatinine determination on admission and one at discharge were analyzed (n = 99). Using longitudinal linear regressions, factors associated to higher creatinine levels on admission and at discharge, AKI, and higher increase in creatinine levels during hospitalization were analyzed. Results: Higher creatinine levels on discharge were seen in older patients (p < 0.003), among those with higher creatinine levels on admission (p < 0.000) and those with higher body mass index (BMI) (p < 0.014). Individuals with higher BMI showed significantly higher increase in creatinine levels (p < 0.05). Conclusions: Our study found that individuals with previous risk factors for AKI showed higher creatinine levels on discharge, but none of these factors predicted AKI significantly.

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“…In our experience with previous kidney substudies, the unadjusted and adjusted results were virtually identical; 18 , 25 nonetheless, to potentially increase the precision of our estimates, 26 we will use a generalized estimating equation approach for binary outcome data, accounting for within-center correlation, adjusting for 9 covariates (measured before randomization) based on their known association with acute kidney injury: age (in years, modeled with restricted cubic splines), sex, cardiovascular disease (any coronary artery disease, peripheral vascular disease, or stroke), diabetes, prerandomization eGFR (as a continuous variable modeled with restricted cubic splines), a history of smoking within 2 years of surgery, urgent or emergency surgery (~6%-7% of POISE-2 participants), 6 and type of surgery (major vascular surgery, major thoracic surgery, or other surgery). We will also adjust for the random allocation of tranexamic acid versus placebo.…”

Section: Methodsmentioning

confidence: 63%

Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial

Garg

Cuerden

Aguado

et al. 2022

Can J Kidney Health Dis

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Background: Most patients who take antihypertensive medications continue taking them on the morning of surgery and during the perioperative period. However, growing evidence suggests this practice may contribute to perioperative hypotension and a higher risk of complications. This protocol describes an acute kidney injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial, which is testing the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy in patients undergoing noncardiac surgery. Objective: To conduct a substudy of POISE-3 to determine whether a perioperative hypotension-avoidance strategy reduces the risk of acute kidney injury compared with a hypertension-avoidance strategy. Design: Randomized clinical trial with 1:1 randomization to the intervention (a perioperative hypotension-avoidance strategy) or control (a hypertension-avoidance strategy). Intervention: If the presurgery systolic blood pressure (SBP) is <130 mmHg, all antihypertensive medications are withheld on the morning of surgery. If the SBP is ≥130 mmHg, some medications (but not angiotensin receptor blockers [ACEIs], angiotensin receptor blockers [ARBs], or renin inhibitors) may be continued in a stepwise manner. During surgery, the patients’ mean arterial pressure (MAP) is maintained at ≥80 mmHg. During the first 48 hours after surgery, some antihypertensive medications (but not ACEIs, ARBs, or renin inhibitors) may be restarted in a stepwise manner if the SBP is ≥130 mmHg. Control: Patients receive their usual antihypertensive medications before and after surgery. The patients’ MAP is maintained at ≥60 mmHg from anesthetic induction until the end of surgery. Setting: Recruitment from 108 centers in 22 countries from 2018 to 2021. Patients: Patients (~6800) aged ≥45 years having noncardiac surgery who have or are at risk of atherosclerotic disease and who routinely take antihypertensive medications. Measurements: The primary outcome of the substudy is postoperative acute kidney injury, defined as an increase in serum creatinine concentration of either ≥26.5 μmol/L (≥0.3 mg/dL) within 48 hours of randomization or ≥50% within 7 days of randomization. Methods: The primary analysis (intention-to-treat) will examine the relative risk and 95% confidence interval of acute kidney injury in the intervention versus control group. We will repeat the primary analysis using alternative definitions of acute kidney injury and examine effect modification by preexisting chronic kidney disease, defined as a prerandomization estimated glomerular filtration rate <60 mL/min/1.73 m2. Results: Substudy results will be analyzed in 2022. Limitations: It is not possible to mask patients or providers to the intervention; however, objective measures will be used to assess acute kidney injury. Conclusions: This substudy will provide generalizable estimates of the effect of a perioperative hypotension-avoidance strategy on the risk of acute kidney injury.

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Predictors of postoperative acute kidney injury in patients undergoing hip fracture surgery: A systematic review and meta-analysis

Cited by 14 publications

References 36 publications

The effect of intra‐operative hypotension on acute kidney injury, postoperative mortality and length of stay following emergency hip fracture surgery

The effect of intra‐operative hypotension on acute kidney injury, postoperative mortality and length of stay following emergency hip fracture surgery

Factors associated with creatinine increase in older adults with hip fracture

Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial

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