nach oben

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

01.12.2012 | Reports of Original Investigations

Acute kidney injury following total joint arthroplasty: retrospective analysis

verfasst von: Toby N. Weingarten, MD, Carmelina Gurrieri, MD, Paul D. Jarett, RN, Deforest R. Brown, RN, Novette J. Berntson, RN, Reynaldo D. Calaro Jr., RN, Daryl J. Kor, MD, Daniel J. Berry, MD, Vesna D. Garovic, MD, Wayne T. Nicholson, MD, Darrell R. Schroeder, MS, Juraj Sprung, MD, PhD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 12/2012

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Postoperative acute kidney injury (AKI) following arthroplasty has not been well studied. Our aim was to identify factors associated with increased risk of AKI.

Methods

The medical records for adult patients who underwent elective total joint arthroplasty during June 1, 2007 to May 31, 2010 at the Mayo Clinic were reviewed to identify patients with normal preoperative kidney function who experienced perioperative AKI, defined as an increase in serum creatinine (sCr) by 26.4 μmol·L⁻¹. For each AKI case, two controls were identified and matched for age, sex, and type of operation. Medical records were abstracted for demographics, comorbid conditions, and preoperative, intraoperative, and postoperative variables. Conditional logistic regression analyses were performed to identify risk factors for AKI.

Results

Of the 9,171 patients who underwent joint replacement operations, 167 with normal preoperative renal function developed AKI with a median [25^th, 75^th] increase in sCr of 35.4 [26.4, 44.2] μmol·L⁻¹. No patient required dialysis. A higher than normal body mass index, diabetes mellitus, the number of baseline antihypertensive medications, cerebral or peripheral vascular disease, use of general anesthesia, and perioperative blood transfusions were independently associated with risk for AKI. Hospital length of stay and intensive care admissions were greater in AKI patients, and in 12.0% of patients, sCr remained at least 26.4 μmol·L⁻¹ higher than preoperative baseline at least three months after surgery.

Conclusion

In this case-control investigation, we identified several factors associated with the development of postoperative AKI. Recognition of these risk factors could allow for the adoption of perioperative renal protective strategies in patients undergoing arthroplasty.

Over 95% of Mayo Clinic patients provided authorization for research use of their medical records.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89: 780-5.PubMedCrossRef

Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005; 87: 1487-97.PubMedCrossRef

Mortazavi SM, Kakli H, Bican O, Moussouttas M, Parvizi J, Rothman RH. Perioperative stroke after total joint arthroplasty: prevalence, predictors, and outcome. J Bone Joint Surg Am 2010; 92: 2095-101.PubMedCrossRef

van Klei WA, Bryson GL, Yang H, Forster AJ. Effect of beta-blocker prescription on the incidence of postoperative myocardial infarction after hip and knee arthroplasty. Anesthesiology 2009; 111: 717-24.PubMedCrossRef

Kheterpal S, Tremper KK, Englesbe MJ, et al. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology 2007; 107: 892-902.PubMedCrossRef

Jafari SM, Huang R, Joshi A, Parvizi J, Hozack WJ. Renal impairment following total joint arthroplasty: who is at risk? J Arthroplasty 2010; 25: 49-53.PubMedCrossRef

Aveline C, Leroux A, Vautier P, Cognet F, Le Hetet H, Bonnet F. Risk factors for renal dysfunction after total hip arthroplasty (French). Ann Fr Anesth Reanim 2009; 28: 728-34.PubMedCrossRef

Berry DJ, Kessler M, Morrey BF. Maintaining a hip registry for 25 years. Mayo Clinic experience. Clin Orthop Relat Res 1997; 344: 61-8.PubMedCrossRef

Alsara A, Warner DO, Li G, Herasevich V, Gajic O, Kor DJ. Derivation and validation of automated electronic search strategies to identify pertinent risk factors for postoperative acute lung injury. Mayo Clin Proc 2011; 86: 382-8.PubMedCrossRef

10.

Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247-54.PubMed

11.

Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.PubMedCrossRef

12.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377-81.PubMedCrossRef

13.

Hosking MP, Warner MA, Lobdell CM, Offord KP, Melton LJ 3rd. Outcomes of surgery in patients 90 years of age and older. JAMA 1989; 261: 1909-15.PubMedCrossRef

14.

World Health Organization. Nutritional Anaemias. Report of a WHO Scientific Group. Geneva, 1968. Available from URL: http://whqlibdoc.who.int/trs/WHO_TRS_405.pdf (accessed September 2012).

15.

Glance LG, Wissler R, Mukamel DB, et al. Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology 2010; 113: 859-72.PubMedCrossRef

16.

Kheterpal S, Tremper KK, Heung M, et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set. Anesthesiology 2009; 110: 505-15.PubMedCrossRef

17.

Chen J, Muntner P, Hamm LL, et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med 2004; 140: 167-74.PubMed

18.

Murugan R, Kellum JA. Acute kidney injury: what’s the prognosis? Nat Rev Nephrol 2011; 7: 209-17.PubMedCrossRef

19.

Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006; 34: 1913-7.PubMedCrossRef

20.

Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 1998; 128: 194-203.PubMed

21.

Bove T, Calabro MG, Landoni G, et al. The incidence and risk of acute renal failure after cardiac surgery. J Cardiothorac Vasc Anesth 2004; 18: 442-5.PubMedCrossRef

22.

Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg 2007; 83: S862-4.PubMedCrossRef

23.

Bihorac A, Yavas S, Subbiah S, et al. Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg 2009; 249: 851-8.PubMedCrossRef

24.

Pavone V, Johnson T, Saulog PS, Sculco TP, Bottner F. Perioperative morbidity in bilateral one-stage total knee replacements. Clin Orthop Relat Res 2004; 421: 155-61.PubMedCrossRef

25.

Grundy SM, Brewer HB, Cleeman JI, Smith SC, American Heart Association, National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004; 109: 433-8.PubMedCrossRef

26.

Anfossi G, Russo I, Doronzo G, Trovati M. Relevance of the vascular effects of insulin in the rationale of its therapeutical use. Cardiovasc Hematol Disord Drug Targets 2007; 7: 228-49.PubMedCrossRef

27.

Abu-Saleh N, Ovcharenko E, Awad H, et al. Involvement of the endothelin and nitric oxide systems in the pathogenesis of renal ischemic damage in an experimental diabetic model. Life Sci 2012; DOI:10.1016/j.lfs.2012.02.002.

28.

Kao MP, Ang DS, Pall A, Struthers AD. Oxidative stress in renal dysfunction: mechanisms, clinical sequelae and therapeutic options. J Hum Hypertens 2010; 24: 1-8.PubMedCrossRef

29.

Scott NB, Turfrey DJ, Ray DA, et al. A prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting. Anesth Analg 2001; 93: 528-35.PubMedCrossRef

30.

Suleiman MY, Passannante AN, Onder RL, Greene-Helms WF, Perretta SG. Alteration of renal blood flow during epidural anesthesia in normal subjects. Anesth Analg 1997; 84: 1076-80.PubMed

31.

Plataki M, Kashani K, Cabello-Garza J, et al. Predictors of acute kidney injury in septic shock patients: an observational cohort study. Clin J Am Soc Nephrol 2011; 6: 1744-51.PubMedCrossRef

32.

Karkouti K, Wijeysundera DN, Yau TM, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 2009; 119: 495-502.PubMedCrossRef

33.

Karkouti K, Wijeysundera DN, Yau TM, et al. Influence of erythrocyte transfusion on the risk of acute kidney injury after cardiac surgery differs in anemic and nonanemic patients. Anesthesiology 2011; 115: 523-30.PubMedCrossRef

34.

Haase M, Bellomo R, Story D, et al. Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute kidney Injury. Nephrol Dial Transplant 2011; 27: 153-60.PubMedCrossRef

35.

Zufferey P, Merquiol F, Laporte S, et al. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology 2006; 105: 1034-46.PubMedCrossRef

36.

Murray MD, Brater DC. Renal toxicity of the nonsteroidal anti-inflammatory drugs. Annu Rev Pharmacol Toxicol 1993; 33: 435-65.PubMedCrossRef

37.

Toto RD, Anderson SA, Brown-Cartwright D, Kokko JP, Brater DC. Effects of acute and chronic dosing of NSAIDs in patients with renal insufficiency. Kidney Int 1986; 30: 760-8.PubMedCrossRef

38.

Lee A, Cooper MG, Craig JC, Knight JF, Keneally JP. Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. Cochrane Database Syst Rev 2007; (2): CD002765.

39.

Carmichael J, Shankel SW. Effects of nonsteroidal anti-inflammatory drugs on prostaglandins and renal function. Am J Med 1985; 78: 992-1000.PubMedCrossRef

40.

Chawla LS. Acute kidney injury leading to chronic kidney disease and long-term outcomes of acute kidney injury: the best opportunity to mitigate acute kidney injury? Contrib Nephrol 2011; 174: 182-90.PubMedCrossRef

Titel: Acute kidney injury following total joint arthroplasty: retrospective analysis
verfasst von: Toby N. Weingarten, MD
Carmelina Gurrieri, MD
Paul D. Jarett, RN
Deforest R. Brown, RN
Novette J. Berntson, RN
Reynaldo D. Calaro Jr., RN
Daryl J. Kor, MD
Daniel J. Berry, MD
Vesna D. Garovic, MD
Wayne T. Nicholson, MD
Darrell R. Schroeder, MS
Juraj Sprung, MD, PhD
Publikationsdatum: 01.12.2012
Verlag: Springer-Verlag
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 12/2012
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-012-9797-2

Neu im Fachgebiet AINS

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Delir bei kritisch Kranken – Antipsychotika versus Placebo

16.05.2024 Delir Nachrichten

Um die Langzeitfolgen eines Delirs bei kritisch Kranken zu mildern, wird vielerorts auf eine Akuttherapie mit Antipsychotika gesetzt. Eine US-amerikanische Forschungsgruppe äußert jetzt erhebliche Vorbehalte gegen dieses Vorgehen. Denn es gibt neue Daten zum Langzeiteffekt von Haloperidol bzw. Ziprasidon versus Placebo.

Eingreifen von Umstehenden rettet vor Erstickungstod

15.05.2024 Fremdkörperaspiration Nachrichten

Wer sich an einem Essensrest verschluckt und um Luft ringt, benötigt vor allem rasche Hilfe. Dass Umstehende nur in jedem zweiten Erstickungsnotfall bereit waren, diese zu leisten, ist das ernüchternde Ergebnis einer Beobachtungsstudie aus Japan. Doch es gibt auch eine gute Nachricht.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Acute kidney injury following total joint arthroplasty: retrospective analysis