Lack of Association Between Levels and Length of Intraoperative Controlled Hypotension and Acute Kidney Injury in Total Hip Arthroplasty Patients Receiving Neuraxial Anesthesia

Abstract

In this study, AKI was rare. We found a lack of association between IOH and postoperative AKI in a setting where neuraxial anesthesia-facilitated IOCH is routinely practiced. Therefore, it seems prudent for future research and clinical guidelines to consider the distinction between inadvertent and controlled hypotension.

Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

“…Six studies [9,10,11,12,13,14] were subsequently excluded because they did not use standard AKI definitions of Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) classifications. Thus, 17 cohort studies [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,37] comprising 24,158 patients undergoing THA were included into the meta-analysis of associated AKI incidence. The literature retrieval, review, and selection process are demonstrated in Figure 1.…”

“…Reported risk factors for AKI in patients undergoing THA are demonstrated in Table 2 [18,19,20,22,23,24,26,27,29,30,31,32,33,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Older age [23,24,26,29,31,55,60], higher body mass index (BMI) [19,22,23,24,26,30,31,46,47,48,49,56,57,59], reduced baseline estimated glomerular filtration rate (eGFR)/chronic kidney disease (CKD) [31,54,55,57,60], diabetes mellitus (DM) [24,26,31,34,47,55,57], nonsteroidal anti-inflammatory drug (NSAID) [23,32,53] use, and perioperative blood transfusion [23,47,53,…”

“…Similar to other types of perioperative AKI, the pathogenesis of THA-related AKI is multifactorial including intraoperative hypotension, perioperative anemia and blood transfusion, antibiotic-related AKI, and nephrotoxic agents such as NSAID use [18,19,20,22,23,24,26,27,29,30,31,32,33,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Our study demonstrated an overall low incidence of AKI following THA of 6.3%, and comparatively much lower than AKI incidence following other types of major surgeries such as coronary artery bypass grafting (AKI incidence approximately 20%) [63,64], vascular surgery (AKI incidence approximately 25%) [35,65], or heart valve replacement surgery (AKI incidence approximately 35% to 47%) [66].…”

“…Previous studies have demonstrated different incidence of AKI following total joint arthroplasties using standard AKI criteria ranging from 0.5% to 22% based on types of joint arthroplasties [5,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. The clinical and economic landscape of joint replacement surgeries including both general orthopedic and more specifically THA is rapidly changing, thus making it imperative for clinicians and administrators to understand the various risk factors and post-operative complications in order to better provide excellence in clinical and financial outcomes.…”

“…The clinical and economic landscape of joint replacement surgeries including both general orthopedic and more specifically THA is rapidly changing, thus making it imperative for clinicians and administrators to understand the various risk factors and post-operative complications in order to better provide excellence in clinical and financial outcomes. However, despite progress in perioperative medicine, the incidence, incidence trend, and risk factors for AKI in patients following THA remain unclear [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. In addition, complication rates such as reoperation and readmission among patients undergoing THA remain high [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33].…”