Incidence of acute kidney injury after elective lower limb arthroplasty.
OBJECTIVE
The aim of this study was to establish the incidence of acute kidney injury (AKI) in patients undergoing elective hip and knee arthroplasty.


METHODS
This was a retrospective cohort study.


METHODS
The study was conducted in a district general hospital in the United Kingdom.


METHODS
All patients undergoing elective hip and knee arthroplasty over a period of 6 months were included in the study.


METHODS
Preoperative and postoperative serum creatinine concentration was recorded in all patients. AKI was defined according to the Acute Kidney Injury Network classification as an increase of serum creatinine concentration of >26.5 μmol/L (≥0.3 mg/dL) or increase to 1.5-fold from baseline.


RESULTS
Three hundred thirty-seven patients were included in the study. Forty-eight had preexisting stage 3 chronic kidney disease (CKD). The overall incidence of AKI in our study was 6.2%. The incidence in patients with preexisting stage 3 CKD (estimated glomerular filtration rate <60 mL/[min 1.73 m(2)]) was 16.3%, whereas in patients without preexisting stage 3 CKD, the incidence was 4.5%.


CONCLUSIONS
We identified stage 3 or higher CKD as a major risk factor for developing postoperative AKI. Preexisting CKD raised the risk of developing AKI 4-fold. We recommend that all patients undergoing lower limb arthroplasty should have renal function assessed preoperatively. In the perioperative period, renal function should be monitored in all patients. This is of particular importance in patients with estimated glomerular filtration rate <60.
Speciality registrar in anaesthesia, Warwickshire School of Anaesthesia; Department of Anaesthesia and Intensive Care, Warwick Hospital, Lakin Rd, Warwick, CV34 5BW, UK. Electronic address: a.nowicka@hotmail.com.
Aleksandra
A
Nowicka
Department of Anaesthesia and Intensive Care, Warwick Hospital, Lakin Rd, Warwick, CV34 5BW, UK. Electronic address: thomasselvaraj@doctors.org.uk.
Thomas
T
Selvaraj
D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
D003404:Creatinine
Acute kidney injury; Lower limb arthroplasty