Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury

Abstract

BackgroundHip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip fracture.MethodsAn observational cohort of consecutive patients with hip fracture in a large UK secondary care hospital. Predictive modelling of outcomes using development and validation datasets. Inclusion: all patients admitted with hip fracture with sufficient serum creatinine measurements to define acute kidney injury. Main outcome measures – development of acute kidney injury during admission; mortality (in hospital, 30-365 day and to follow-up); length of hospital stay.ResultsData were available for 2848 / 2959 consecutive admissions from 2007-2011; 776 (27.2%) male. Acute kidney injury occurs in 24%; development of acute kidney injury is independently associated with male sex (OR 1.48 (1.21 to 1.80), premorbid chronic kidney disease stage 3B or worse (OR 1.52 (1.19 to 1.93)), age (OR 3.4 (2.29 to 5.2) for >85 years) and greater than one major co-morbidities (OR 1.61 (1.34 to 1.93)). Acute kidney injury of any stage is associated with an increased hazard of death, and increased length of stay (Acute kidney injury: 19.1 (IQR 13 to 31) days; no acute kidney injury 15 (11 to 23) days). A simplified predictive model containing Age, CKD stage (3B-5), two or more comorbidities, and male sex had an area under the ROC curve of 0.63 (0.60 to 0.67).ConclusionsAcute kidney injury following hip fracture is common and associated with worse outcome and greater hospital length of stay. With the number of people experiencing hip fracture predicted to rise, recognition of risk factors and optimal perioperative management of acute kidney injury will become even more important.

Incidence, morbidity and mortality of hip fractures over a period of 20 years in a health area of Southern Spain

“…44 The presence of renal failure in hip fracture patients has been associated with an increased risk of death and prolonged hospital stay. 45…”

Functional Outcomes After Hip Fracture in Independent Community‐Dwelling Patients

“…The presence of several comorbidities shown to be associated with poor outcomes in patients with hip fracture were adjudicated from electronic patient charts: dementia, 1,3,9,12,16,17 congestive heart failure (CHF), 26,27 chronic kidney disease (CKD), [28][29][30] and depression. 31 Each condition was recognized as present if cited in the patient's problem lists or physician notes.…”

Perioperative management of patients with renal insufficiency

“…Стандартный набор тестов обычно не показывает каких-либо отклонений (протромбиновое время/МНО, АЧТВ), число тромбоцитов также находится в пределах нормы [28]. Однако активность тромбоцитов под влиянием уремических токсинов обычно нарушена, что проявляется снижением их адгезивных и агрегационных свойств вследствие неадекватного высвобождения из сосудистого эндотелия комплекса фактора фон Виллебранда и фактора VIII, который в норме связывается и активирует тромбоциты.…”

“…Однако активность тромбоцитов под влиянием уремических токсинов обычно нарушена, что проявляется снижением их адгезивных и агрегационных свойств вследствие неадекватного высвобождения из сосудистого эндотелия комплекса фактора фон Виллебранда и фактора VIII, который в норме связывается и активирует тромбоциты. Нарушение адгезии тромбоцитов также связано с избыточной продукцией оксида азота [28]. Дисфункция тромбоцитов не может быть устранена при помощи трансфузии тромбоцитной массы, но степень ее выраженности снижается после проведения диализа.…”