title: Total Joint Arthroplasty in Patients with Chronic Renal Disease: Is It Worth the Risk?
abstract: 26-27% of patients with end stage hip and knee arthritis requiring TJR have chronic renal disease. A multi-center, prospective clinical registry was queried for TJA's from 2006 to 2012, and 74,300 cases were analyzed. Renal impairment was quantified using estimated glomerular filtration rate (eGFR) to stratify each patient by stage of CRD (1-5). There was a significantly greater rate of overall complications in patients with moderate to severe CRD (6.1% vs. 7.6%, P<0.001). In those with CRD (Stage 3-5), mortality was twice as high (0.26% vs. 0.48%, P<0.001). Patients with Stage 4 and 5 CRD had a 213% increased risk of any complication (OR 2.13, 95% CI: 1.73-2.62). Surgeons may use these findings to discuss the risk-benefit ratio of elective TJR in patients with CRD.
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Lucian C
authors.initials: LC
authors.lastname: Warth
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Martin
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.affiliation: University of Iowa, Iowa City, Iowa.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
mesh_terms: D000368:Aged; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D016017:Odds Ratio; D058991:Patient Protection and Affordable Care Act; D011446:Prospective Studies; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States
keywords: ACS NSQIP; chronic renal disease; database; eGFR (estimated glomerular filtration rate); total joint arthroplasty