Risk Factors for Acute Kidney Injury After Hip Fracture Surgery in the Elderly Individuals

Abstract

Objective: We aimed to evaluate possible risk factors assocıated wıth acute kidney injury (AKI) after hip fracture surgery in the elderly individuals. Design: Level II diagnostic study, evidence obtained from prospective cohort study from 1 center with level 2, and 3 patients. Patients: A total of 165 patients (>65 years) with femoral neck fracture were enrolled in this prospective study between 2007 and 2010. Two patients were dropped for inadequate laboratory follow-up data. Patients with kidney failure or renal replacement therapy (RRT) history or AKI at admission were excluded. Intervention: Nephrology consultation was obtained from all patients at admission. All patients had undergone bipolar cemented hip arthroplasty that was performed by the same surgical team in all patients within 24 hours of fracture and admission under the same protocol. Main Outcome Measurements: Serum creatinine (SCr), urine output, and complete blood counts were evaluated at baseline and daily basis thereafter. The AKI was defined based on Acute Kidney Injury Network classification. Hospital charges were converted from Turkish Liras to US dollars and rounded. Results: Among 163 patients, AKI occurred in 25 (15.3%) patients, all within the first 48 postoperative hours. Three (1.8%) patients required RRT. Baseline SCr levels were restored within 4.84 + 1.34 days on average (3-8 days). No patient required RRT after discharge. The mean hospital stay was 3 days (2-6 days) longer and the hospital charge was 2500 US$ higher for the patients with AKI. After multivariable adjustment, only lower estimated glomerular filtration rate levels (odds ratio 0.945, 95%confidence interval 0.92-0.96) emerged as an independent predictor for AKI. Conclusion: The AKI represents a frequent complication after hip fracture surgery associated with longer hospital stay and higher treatment costs with increased morbidity. Our results show baseline renal function is an independent predictor of AKI.

Risk Factors for Colistin-Associated Acute Kidney Injury: A Multicenter Study from Turkey

“…(28,29). Our study similarly showed that a higher baseline creatinine level is an independent risk factor for AKI.…”

The Doppler renal resistive index for early detection of acute kidney injury after hip fracture

“…Some authors suggest monitoring hourly urinary output in hip fracture patients. 4 However, AKI can exist even when urine output is normal. 7 On the other hand, oliguria can be an adaptive mechanism and is not systematically associated with AKI.…”

“…A c c e p t e d M a n u s c r i p t 4 The Doppler renal resistive index (RI) can be an effective means of early postoperative AKI diagnosis in scheduled major orthopaedic surgery. 8 However, to date, no predictive tool has been proposed in the case of hip fracture surgery.…”

“…Perioperative acute kidney injury (AKI) is an additional risk factor linked to prolonged hospital stay, increased morbidity and mortality, and poor outcome. 4 Postoperative AKI after hip fracture surgery is due to a combination of hypovolaemia and hypotension and may be exacerbated by nephrotoxic medications or pre-existing medical conditions such as vascular disease, which are known to predispose patients to AKI in the context of hypoperfusion. 5 Rapid perioperative detection and treatment of organ decompensation may result in a lower number of postoperative complications and consequently lower mortality rates subsequent to hip fracture surgery.…”

Total hip replacement for neck of femur fracture: Comparing outcomes with matched elective cohort

“…Postoperative complications may affect up to 20% of patients with hip fracture and the incidence of acute kidney injuries (AKI) among patients undergoing 9 9 arthroplasty for NOF# ranges between 16% to 24.4% in the literature (24,28).…”