title: Risk factors associated with acute kidney injury in a cohort of 20,575 arthroplasty patients.
abstract: Background and purpose - Patients developing postoperative acute kidney injury (AKI) are at risk of higher morbidity and mortality. In arthroplasty patients, many pre- and perioperative factors are associated with AKI but some of the risk factors are unclear. We report the incidence of postoperative AKI, the conditions associated with it, and survival rates in AKI patients. Patients and methods - We obtained data from 20,575 consecutive hip or knee arthroplasties. Postoperative AKI, occurring within 7 days after the operation, was defined using the risk, injury, failure, loss, and end-stage (RIFLE) criteria. We analyzed independent risk factors for AKI using binary logistic regression. In addition, we reviewed the records of AKI patients and performed a survival analysis. Results - The AKI incidence was 3.3 per 1,000 operations. We found preoperative estimated glomerular filtration rate, ASA classification, body mass index, and duration of operation to be independent risk factors for AKI. Infections, paralytic ileus, and cardiac causes were the predominant underlying conditions, whereas half of all AKI cases occurred without any clear underlying condition. Survival rates were lower in AKI patients. Interpretation - Supporting earlier results, existing renal insufficiency and patient-related characteristics were found to be associated with an increased risk of postoperative AKI. Furthermore, duration of operation was identified as an independent risk factor. We suggest careful renal monitoring postoperatively for patients with these risk factors.
authors.affiliation: a Coxa Hospital for Joint Replacement.
authors.forename: Pyry
authors.initials: P
authors.lastname: Jämsä
authors.affiliation: a Coxa Hospital for Joint Replacement.|b School of Medicine , University of Tampere.
authors.forename: Esa
authors.initials: E
authors.lastname: Jämsen
authors.affiliation: b School of Medicine , University of Tampere.|c Department of Clinical Chemistry , University of Tampere.|d Fimlab Laboratories.
authors.forename: Leo-Pekka
authors.initials: LP
authors.lastname: Lyytikäinen
authors.affiliation: a Coxa Hospital for Joint Replacement.|b School of Medicine , University of Tampere.
authors.forename: Jarkko
authors.initials: J
authors.lastname: Kalliovalkama
authors.affiliation: a Coxa Hospital for Joint Replacement.
authors.forename: Antti
authors.initials: A
authors.lastname: Eskelinen
authors.affiliation: b School of Medicine , University of Tampere.|e Department of Surgery, Faculty of Medicine and life sciences , Tampere University Hospital , Tampere , Finland.
authors.forename: Niku
authors.initials: N
authors.lastname: Oksala
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000401:mortality; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000401:mortality; D015992:Body Mass Index; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D055815:Young Adult