Ali Vial Izziddine Ahmad, Babar Tehmoor, Boutros Ihab
Manchester Medical School, Stopford Building, Oxford Rd, Manchester, M13 9PT, United kingdom.
Department of Orthopaedic Surgery, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, Manchester, United Kingdom.
J Clin Orthop Trauma. 2020 Mar;11(Suppl 2):S255-S259. doi: 10.1016/j.jcot.2019.10.012. Epub 2019 Nov 5.
Acute Kidney Injury (AKI) is a common complication post-arthroplasty, although it has not been extensively studied. We carried out a retrospective study to determine the incidence and risk factors of AKI in patients undergoing total joint arthroplasty (TJA).
We reviewed the medical records of all patients who underwent elective TJA from December 2014 to January 2017 at the Salford Royal Hospital, UK. AKI was defined using the AKIN, RIFLE and KDIGO criteria in patients with worsened renal function post-arthroplasty. We analysed the association of the demographics, risk factors, medications and use of peri-operative IV fluids with AKI. A logistic regression was performed to find any correlation between these factors and incidence of AKI.
197 patients were included in our study, the mean age was 70.2 and male to female ratio was 6:5. Of these, 32(16.2%) developed an AKI. The multivariate logistic regression revealed 4 independent factors associated with the risk of AKI; age (P = 0.0011, OR 1.07, 95% CI 1.03-1.18), obesity (P = 0.003, OR 6.4, 95% CI 2.34-17.5), smoking (P = 0.0482, OR 3.76, 95% CI 1.01-14.0) and COPD (P = 0.0253, OR 3.85, 95% CI 1.18-12.5).
The incidence of AKI post-arthroplasty was found to be much higher than stated in other literatures. The recognition of the high incidence and multiple independent risk factors will allow a better approach to peri-operative management, limiting the risks of AKI. Our study also highlighted the importance of documenting urine output and the need to repeat the renal function test 3 months after an AKI to assess recovery.
急性肾损伤（AKI）是关节置换术后常见的并发症，尽管尚未得到广泛研究。我们进行了一项回顾性研究，以确定全关节置换术（TJA）患者中AKI的发生率和危险因素。
我们回顾了2014年12月至2017年1月在英国索尔福德皇家医院接受择期TJA的所有患者的病历。使用AKIN、RIFLE和KDIGO标准对关节置换术后肾功能恶化的患者进行AKI定义。我们分析了人口统计学、危险因素、药物治疗以及围手术期静脉输液的使用与AKI之间的关联。进行逻辑回归分析以找出这些因素与AKI发生率之间的任何相关性。
我们的研究纳入了197例患者，平均年龄为70.2岁，男女比例为6:5。其中，32例（16.2%）发生了AKI。多因素逻辑回归显示与AKI风险相关的4个独立因素；年龄（P = 0.0011，OR 1.07，95% CI 1.03 - 1.18）、肥胖（P = 0.003，OR 6.4，95% CI 2.34 - 17.5）、吸烟（P = 0.0482，OR 3.76，95% CI 1.01 - 14.0）和慢性阻塞性肺疾病（COPD）（P = 0.0253，OR 3.85，95% CI 1.18 - 12.5）。
发现关节置换术后AKI的发生率远高于其他文献报道。认识到高发生率和多个独立危险因素将有助于更好地进行围手术期管理，降低AKI风险。我们的研究还强调了记录尿量的重要性以及在AKI发生3个月后重复进行肾功能测试以评估恢复情况的必要性。
