Occurrence and predictive factors of acute renal injury following hip and knee arthroplasty

Ma, Yi; Fang, Kaiyun; Gang, Shaopeng; Peng, Jing; Jiang, Ling; He, Fujuan; Wang, Zhenghua; Li, Sun; Zhu, Yan

doi:10.1007/s10157-020-01874-z

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…Several studies have confirmed the correlation between low or deficient nutrients and the development of AKI in patients with infectious diseases, cancer, surgery and other causes of critical illness, showing that malnutrition is an independent risk factor and suggesting that following AKI guidelines to prevent and treat AKI by providing nutritional support, especially to children and elderly patients (110)(111)(112)(113)(114). In addition, similar views have been proposed in several studies on risk factors assessment for surgery-related AKI, as well as studies on the correlation between preoperative prognostic nutritional index and AKI, it was suggested that perioperative nutritional status of patients is closely related to the occurrence of AKI (61)(62)(63)(64)(65).…”

Section: Malnutritionmentioning

confidence: 87%

Analysis of Risk Factors for Perioperative Acute Kidney Injury and Management Strategies

Xia

Feng

2021

Front. Med.

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Acute kidney injury (AKI) is a serious clinical syndrome, and one of the common comorbidities in the perioperative period. AKI can lead to complications in surgical patients and is receiving increasing attention in clinical workup. In recent years, the analysis of perioperative risk factors has become more in-depth and detailed. In this review, the definition, diagnosis, and pathophysiological characteristics of perioperative AKI are reviewed, and the main risk factors for perioperative AKI are analyzed, including advanced age, gender, certain underlying diseases, impaired clinical status such as preoperative creatinine levels, and drugs that may impair renal function such as non-steroidal anti-inflammatory drugs (NASIDs), ACEI/ARB, and some antibiotics. Injectable contrast agents, some anesthetic drugs, specific surgical interventions, anemia, blood transfusions, hyperglycemia, and malnutrition are also highlighted. We also propose potential preventive and curative measures, including the inclusion of renal risk confirmation in the preoperative assessment, minimization of intraoperative renal toxin exposure, intraoperative management and hemodynamic optimization, remote ischemic preadaptation, glycemic control, and nutritional support. Among the management measures, we emphasize the need for careful perioperative clinical examination, timely detection and management of AKI complications, administration of dexmedetomidine for renal protection, and renal replacement therapy. We aim that this review can further increase clinicians' attention to perioperative AKI, early assessment and intervention to try to reduce the risk of AKI.

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Section: Malnutritionmentioning

confidence: 87%

Analysis of Risk Factors for Perioperative Acute Kidney Injury and Management Strategies

Xia

Feng

2021

Front. Med.

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“…CKD patients are in a high‐risk state during the perioperative period, and adverse events can occur postoperatively. Age, male sex, and complications were all independent predictors of postoperative creatinine elevation in CKD patients 1 . Studies have indicated, that compared with non‐CKD patients, CKD patients showed worse health conditions and had higher rates of comorbidities and complications in the perioperative period of joint arthroplasty 2,3 .…”

Section: Introductionmentioning

confidence: 98%

“…Age, male sex, and complications were all independent predictors of postoperative creatinine elevation in CKD patients. 1 Studies have indicated, that compared with non-CKD patients, CKD patients showed worse health conditions and had higher rates of comorbidities and complications in the perioperative period of joint arthroplasty. 2,3 In addition, there have been studies showing that CKD/end-stage renal disease (ESRD) patients had a greater risk of postoperative surgical site infections and wound complications than non-CKD patients, especially CKD/ESRD patients receiving dialysis therapy.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of the Perioperative Period Management of Joint Arthroplasty in Patients with Chronic Kidney Disease

Jin

Yang

et al. 2022

Orthopaedic Surgery

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Objective With the rising prevalence of chronic kidney disease (CKD) and the increasing demand for joint arthroplasty, the management of CKD patients in the perioperative period of joint arthroplasty has become an issue worthy of attention for orthopedic surgeons. This study aimed to explore comprehensive perioperative period management strategies for CKD patients. Methods From March 2017 to August 2022, 62 patients who underwent joint arthroplasty in our hospital were included in a retrospective study, including 31 CKD patients (mean age 69.8 ± 13.4 years old) and 31 non‐CKD patients (mean age 69.4 ± 14.2 years old). The outcome indicators were analyzed, including serum urea, serum creatinine, blood uric acid, hematocrit, and hemoglobin. Results All patients included in the retrospective study had an average preoperative preparation time of 4.3 ± 2.6 days and an average hospitalization time of 11.0 ± 7.3 days. There were no significant differences in the changes in the serum urea values between the preoperative and postoperative measurements in the CKD patients or in the serum creatinine values and blood uric acid values (P > 0.05). The hemoglobin value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.05). The hematocrit value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.001). Conclusion Patients with CKD have distinct characteristics compared to non‐CKD patients, and they generally have a higher risk for postoperative complications and adverse events. Recognition of risk factors, suitable timing of surgery, the undertaking of protective strategies, and proper management of complications are vital for managing CKD patients in the perioperative period of joint arthroplasty.

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“…Bundlecare payment for TJA has helped to curb this increased financial burden in recent years, pushing different specialties to work together to provide cost-efficient and time-efficient care that benefits the patient and the hospital system. 11 AKI and hypotension potentially leading to AKI, in particular, have garnered increased attention and analysis as a potentially preventable and treatable complication, 12,13 with AKI rates as high as 16.2% being documented after TJA. Noteworthy is that this rate is likely underestimated because of failure to properly recognize and code for AKI (not recognizing AKI based on KDIGO criteria, not testing for postoperative creatinine levels, and institutional differences in coding can all account for this underreporting).…”

mentioning

confidence: 99%

Preventing Acute Kidney Injury and Hypotension After Elective Total Joint Arthroplasty Is Possible: An Update to an Established Multidisciplinary Protocol

Malige

Carmona

Roscher

et al. 2021

J Am Acad Orthop Surg

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Introduction: Based on preoperative and perioperative risk factors that have been found to correlate with the development of acute kidney injury (AKI), our institution developed a protocol aimed at managing and improving outcomes in all elective THA and TKA patients. This article highlights the continued success and growth of our protocol aimed at decreasing AKI and hypotension in elective total joint arthroplasty patients. Method: A multidisciplinary team comprising orthopaedic surgeons, nephrologists, anesthesiologists, cardiologists, and internal medicine hospitalists created a comprehensive protocol aimed at decreasing complications after elective joint arthroplasty and improving clinical outcomes across multiple hospitals. Patient demographics, hospital length of stay, readmission rates, mortality, and postoperative AKI and hypotension incidences were recorded and compared between preprotocol phase I (initial protocol implementation) and phase II (protocol expansion across 10 hospitals) patient cohorts. Results: Overall, 3,222 patients over 56 months and 10 hospitals were included. Our phase II AKI rate (0.6%) was significantly lower than our preprotocol rate (6.2%, P < 0.01) and statistically similar to our phase I rate (1.2%, P = 0.61). Our hypotension rate in phase II (6.8%) was significantly lower than our preprotocol rate (12.7%, P < 0.01) but statistically similar to our phase I rate (5.9%, P = 0.40). Furthermore, a significant decrease was observed in hospital length of stay (P < 0.01) over time, but no difference was observed in readmission (P = 0.59) and mortality rates (P = 1.00) over time. Discussion: This protocol-driven interventional study provides a detailed and successful multidisciplinary method to manage and decrease rates of AKI and hypotension in a large patient cohort across multiple hospital centers.

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Occurrence and predictive factors of acute renal injury following hip and knee arthroplasty

Cited by 7 publications

References 21 publications

Analysis of Risk Factors for Perioperative Acute Kidney Injury and Management Strategies

Analysis of Risk Factors for Perioperative Acute Kidney Injury and Management Strategies

A Retrospective Study of the Perioperative Period Management of Joint Arthroplasty in Patients with Chronic Kidney Disease

Preventing Acute Kidney Injury and Hypotension After Elective Total Joint Arthroplasty Is Possible: An Update to an Established Multidisciplinary Protocol

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