The prevalence and risk factors of acute kidney injury in patients undergoing hip fracture surgery: a meta-analysis

Li, Zi‐Cai; Pu, Yanchuan; Wang, Jin; Wang, Hu-Lin

doi:10.1080/21655979.2021.1926200

Cited by 10 publications

(6 citation statements)

References 31 publications

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“… 25 Moreover, a recent meta-analysis consisting of 11 studies with 16,421 surgical hip fracture patients found the pooled prevalence of AKI was 17% (95% CI 14–21%). 28 Compared with those studies, the incidence of AKI in the current study was much higher (48.2%) and might at least partly explained by differences in patient populations and severity of disease. Furthermore, rib fracture patients especially in ICU occasionally require surgical treatment and commonly complain about chest pain, atelectasis, hypoventilation, hypoxemia, respiratory failure and subsequent cardiac complications.…”

Section: Discussioncontrasting

confidence: 84%

Blood Urea Nitrogen to Serum Albumin Ratio in the Prediction of Acute Kidney Injury of Patients with Rib Fracture in Intensive Care Unit

He¹,

Li²,

Xu³

et al. 2022

IJGM

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Background We hypothesized that the blood urea nitrogen (BUN) to serum albumin ratio (BAR) could serve as an independent predictor for incident acute kidney injury (AKI) in intensive care unit (ICU) patients with rib fracture. Methods Rib fracture patients in ICU were extracted from Medical Information Mart for Intensive Care IV (MIMIC-IV v1.0) database. The primary outcome in this study was the incidence of AKI. Univariate and multivariate logistic regression analyses were used to determine the relationship between BAR and AKI and propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were also applied to assure the robustness of our results. Results The optimal cut-off value for BAR was 5.26 based on receiver operator characteristic curve. Among the 953 patients who diagnosed with rib fracture, 197 high-BAR group (≥5.26) patients and 197 low-BAR group (<5.26) patients who had similar propensity scores were finally included in the matched cohort. High-BAR group patients had a significantly higher incidence of AKI (odds ratio, OR, 3.85, 95% confidence index, 95% CI, 2.58–5.79, P<0.001) in the original cohort, in the matched cohort (OR, 4.47, 95% CI 2.71–7.53, P<0.001), and in the weighted cohort (OR, 4.28, 95% CI 2.80–6.53, P<0.001). Furthermore, BAR was superior to that of acute physiology score III for predicting AKI and could add more net benefit for incident AKI in critical care patients with rib fracture. Conclusion As an easily access and cost-effective parameter, BAR could serve as a good diagnostic predictor for AKI in ICU patients with rib fracture.

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Section: Discussioncontrasting

confidence: 84%

Blood Urea Nitrogen to Serum Albumin Ratio in the Prediction of Acute Kidney Injury of Patients with Rib Fracture in Intensive Care Unit

He¹,

Li²,

Xu³

et al. 2022

IJGM

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“…Previous studies proposed that risk factors such as age, gender, BMI, preexisting CKD, pre-and postoperative hypoalbuminemia, comorbidities, hemoglobin changes, blood loss, and other factors were independent risk factors for AKI, 9,[13][14][15][16] although some other studies identified different risk factors. 11,12 Chen et al studied patients following orthopedic surgery and proposed that age, hypertension, DM, hypoproteinemia, receipt of transfusion, and duration of low mean arterial pressure were independent risk factors for AKI. 17 We analyzed the and many other factors, and our multivariate logistic regression results indicated that advanced age, high ASA score, preexisting CKD, receipt of cemented surgery, and large decrease of hemoglobin on the first day after surgery were significant and independent risk factors for AKI.…”

Section: Discussionmentioning

confidence: 99%

“…10 Many risk factors of AKI after hip fracture surgery had been identified in literature. [7][8][9]11 There have also been efforts to develop interventions for the prevention and treatment of AKI after hip fracture surgery based on these reported risk factors. However, rare predictive model for AKI after hip fracture surgery is currently available.…”

Section: Introductionmentioning

confidence: 99%

Construction and Validation of a Nomogram for Predicting Acute Kidney Injury After Hip Fracture Surgery

Pan¹,

Liu²,

Wu³

et al. 2023

CIA

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Background: Acute kidney injury (AKI), characterized by sudden impairment of kidney function, is an uncommon complication following hip fracture surgery that is associated with increased morbidity and mortality. We constructed a nomogram to stratify patients according to risk of AKI after hip fracture surgery to guide clinicians in the implementation of timely interventions. Methods: Patients who received hip fracture surgery from January 2015 to December 2021 were retrospectively identified and divided into a training set (n=448, surgery from January 2015 to December 2019) and a validation set (n=200, surgery from January 2020 to December 2021). Univariate and multivariate logistic regression were used to identify risk factors for AKI after surgery in the training set. A nomogram was constructed based the risk factors for AKI, and was evaluated by receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA). Results: The mean age was 82.0±6.22 years-old and the prevalence of post-surgical AKI was 13.3%. Age, American Society of Anesthesiologists (ASA) score, the preexistence of chronic kidney disease (CKD), cemented surgery and the decrease of hemoglobin on the first day after surgery were identified as independent risk factors of AKI after hip fracture surgery, and a predictive nomogram was established based on the multivariable model. The predictive nomogram had good discrimination ability (training set: AUC: 0.784, 95% CI: 0.720-0.848; validation set: AUC: 0.804, 95% CI: 0.704-0.903), and showed good validation ability and clinical usefulness based on a calibration plot and decision curve analysis. Conclusion: A nomogram that incorporated five risk factors including age, ASA score, preexisting CKD, cemented surgery and the decrease of hemoglobin on the first day after surgery had good predictive performance and discrimination. Use of our results for early stratification and intervention has the potential to improve the outcomes of patients receiving hip fracture surgery. Future large, multicenter cohorts are needed to verify the model's performance.

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“…A large-scale cohort study estimated the incidence of AKI for postoperative T&O patients at 10.8% 6. Studies focusing on AKI following elective procedures found rates of 6.8%5 and 8.2%1 compared with 17% of patients following emergency surgery 3 7. Importantly, while undergoing an operation is in itself a risk factor for developing an AKI, emergency T&O patients in particular are often at greater risk, given their frailty and comorbidities 3…”

Section: Problemmentioning

confidence: 99%

Reducing incidence of postoperative acute kidney injury in trauma and orthopaedics patients: a quality improvement project

et al. 2023

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BackgroundAcute kidney injury (AKI) is a common postoperative complication which increases morbidity and mortality. This quality improvement project aimed to implement measures targeting known risk factors to decrease the incidence of postoperative AKI in trauma and orthopaedics (T&O) patients.MethodsData were collected across three six-month to 7-month cycles between 2017 and 2020, analysing all elective and emergency T&O operated patients within a single NHS Trust (n=714, 1008 and 928, respectively). Patients who developed a postoperative AKI were identified using biochemical criteria and data were collected on known AKI risk factors, including use of nephrotoxic medications, and patient outcomes. In the final cycle, the same variables were collected for patients without AKI. Between cycles, measures implemented included: preoperative and postoperative medication reconciliation aiming to stop nephrotoxic medications, orthogeriatrician review of high-risk patients and junior doctor teaching on fluid therapy. Statistical analysis was undertaken to determine the incidence of postoperative AKI across cycles, prevalence of risk factors and impact on length of hospital stay and postoperative mortality.ResultsThere was a statistically significant decrease in postoperative AKI incidence from 4.27% (43 of 1008 patients) in cycle 2 to 2.05% (19 of 928) in cycle 3 (p=0.006), with a notable decrease in use of nephrotoxic medications. Significant predictors for the development of postoperative AKI included use of diuretics and receiving multiple nephrotoxic drug classes. Development of postoperative AKI significantly increased length of hospital stay by 7.11 days on average (95% CI: 4.84 to 9.38 days, p<0.001) and risk of 1-year postoperative mortality (OR 3.22, 95% CI: 1.03 to 10.55, p=0.046).ConclusionThis project demonstrates that a multifaceted approach targeting modifiable risk factors can reduce incidence of postoperative AKI in T&O patients, which may lead to reduced length of hospital stay and postoperative mortality.

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The prevalence and risk factors of acute kidney injury in patients undergoing hip fracture surgery: a meta-analysis

Cited by 10 publications

References 31 publications

Blood Urea Nitrogen to Serum Albumin Ratio in the Prediction of Acute Kidney Injury of Patients with Rib Fracture in Intensive Care Unit

Blood Urea Nitrogen to Serum Albumin Ratio in the Prediction of Acute Kidney Injury of Patients with Rib Fracture in Intensive Care Unit

Construction and Validation of a Nomogram for Predicting Acute Kidney Injury After Hip Fracture Surgery

Reducing incidence of postoperative acute kidney injury in trauma and orthopaedics patients: a quality improvement project

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