Predictors of Acute Kidney Injury in Geriatric Patients Undergoing Total Knee Replacement Surgery

Abstract

Background:Few studies have focused on patients’ characteristics that affects acute kidney injury (AKI) after total knee replacement surgery (TKR).Objectives:The primary objective of this retrospective study was to identify patients’ characteristics associated with AKI after TKR.Patients and Methods:Between January 2008 and December 2009, 659 patients with a mean age of 67.1 years (range, 39-99) underwent TKA at Regional Hospital Knee and Hip Institute. Retrospective chart review was done to identify patients’ characteristics that were associated with AKI after TKR. Logistic regression was used to evaluate AKI.Results:AKI occurred in 21.9% of patients. AKI risk decreased between 2008 and 2009 (odds ratio, 0.55; 95% CI, -0.37 to 0.82) but increased with age (P < 0.001), diabetes mellitus (DM), and angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) use (OR, -1.6; 95% CI, -1.0 to 2.5; and OR, -1.5, 95% CI, -1.0 to 2.3, respectively). However, the effects of DM and ACEI/ARB use were not independent; when both were included in the regression model, neither was statistically significant, and both ORs were smaller than combined OR.Conclusions:When examined separately, both DM and preoperative ACEI/ARB use increased the risk of AKI; however these factors were correlated and were not independent predictors of significantly increased risk. Patients with DM have higher tendency to develop AKI and hence, preoperative renal risk stratification should be done in all patients with DM.

Acute kidney injury after hip or knee replacement: Can we lower the risk?

“…Sehgal et al 9 found an incidence of 21.9% in 659 total joint arthroplasties using AKIN creatinine criteria.…”

Do statins prevent acute kidney injury?

“…The impact of statins on AKI due to surgery (Table 4) AKI is common after major elective surgery affecting up to 30% of patients [46][47][48][49][50][51][52] dependent on the type surgery and the age and frailty of the patient group. The main mechanism of post-operative AKI is thought to be impaired perfusion leading to renal ischaemia.…”

Acute kidney injury after cardiac and non-cardiac surgery: are there more similarities than differences?

“…Major procedures known to be commonly complicated by AKI now include major vascular surgery, liver transplants, esophagogastrectomy, gastric bypass, thoracotomy, liver resections, and total knee replacements. 11,12 As highlighted above, different AKI syndromes occur in varied settings and with a spectrum of risk factors (e.g., rhabdomyolysis) that sometimes advocate for specific therapies.…”

“…Les interventions majeures connues comme étant souvent compliquées par une IRA incluent dorénavant les chirurgies vasculaires majeures, les greffes hépatiques, l'oesophagogastrectomie, le pontage gastrique, la thoracotomie, les résections hépatiques et les arthroplasties totales du genou. 11,12 Comme nous l'avons souligné ci-dessus, différents syndromes d'IRA surviennent dans différents contextes et sont associés à un éventail de facteurs de risque (par ex., la rhabdomyolyse) qui préconisent des traitements spécifiques.…”