title: Chronic Kidney Disease Linearly Predicts Outcomes After Elective Total Joint Arthroplasty.
abstract: Kidney disease is associated with increased complications in total joint arthroplasty (TJA). The purpose of this study was to determine the association of kidney disease severity as measured by the chronic kidney disease (CKD) staging system with complications after TJA.
  
  
  
  A retrospective review of 12,308 primary TJAs (6361 hips and 5947 knees) from 2008 to 2013 was performed. The following preoperative variables were obtained from medical records: chemistry 7 panel, Elixhauser comorbidities, and demographic factors. CKD stages were defined based on estimated glomerular filtration rate (eGFR) in mL/min/1.73m(2): (1) 90+, (2) 60-89, (3A) 45-59, (3B) 30-44, (4) 15-29, and (5) <15. Multivariate analysis was performed to assess the independent influence of CKD stage on the aforementioned end points.
  
  
  
  Patients with CKD stage greater than 2 demonstrated an increased odds of receiving transfusions (P = .001), length of stay >3 days (P = .010), acute kidney injury (P < .001), septic revisions (P = .002), and in-hospital complications (P < .001) compared with all patients with eGFR ≥60 when controlling for potential confounders. Only CKD stage 3A was significantly associated with septic revisions (90 days, P = .004; 2 years P = .002). In addition, the relationship between eGFR and the previously mentioned complications increased linearly rather than demonstrating a clear threshold at which the risk increased substantially.
  
  
  
  Severe CKD is associated with increased transfusion, length of stay, and in-hospital complications; and complications increased linearly with disease severity. Surgeons should be cognizant of this increase when evaluating TJA patients with renal disease.
authors.affiliation: The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Tan
authors.affiliation: The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kheir
authors.affiliation: The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Dean D
authors.initials: DD
authors.lastname: Tan
authors.affiliation: The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Filippone
authors.affiliation: The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Tischler
authors.affiliation: The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D001178:Arthroplasty / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001803:Blood Transfusion / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: chronic kidney disease; comorbidities; in-hospital complications; renal disease; total joint arthroplasty