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Kidney Week

Abstract: TH-PO086

Incidence and Risk Factors of AKI After Total Hip Arthroplasty or Revision in Kidney Transplant Recipients (KTx)

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Thirunavukkarasu, Sorkko, Mayo Clinic, Rochester, Minnesota, United States
  • Zoghby, Ziad, Mayo Clinic, Rochester, Minnesota, United States
Background

Immunosuppressive regimens increase the risk of bone complications such avascular necrosis and osteoporosis in KTx. Treatment of choice is Arthroplasty but limited data show that adverse events, specifically AKI is higher in KTx (16-26.6%) compared to the general population (1.1%). AKI has been linked to increased morbidity and mortality. Our aim was to determine the incidence of AKI in KTx undergoing primary hip arthroplasty (THA)or revision (THA-R), identify risk factors associated with AKI and evaluate its effect on allograft function at 1 year.

Methods


Using the orthopedic and transplant databases, we designed a case-control study of 102 patients undergoing a total of 141 THA and THA-R between 2000 and 2018 at the Mayo Clinic. Variables of interest not available in the databases were obtained through chart review. AKI was defined per the current KIDGO guideline.

Results

The average age at surgery was 59 years (range 27-82); with 58% male and 96% white. The most common surgical indications for THA were degenerative joint disease (57%), avascular necrosis (27%), and fractures (12%); and for THA-R, loosening (28%), dislocation (22.7%) and Infection (9%). The incidence of AKI was 10.4% and 17% in THA and THA-R, respectively (p=0.36). All AKI were stage 1 per AKIN criteria. Anesthesia time was longer in patients with AKI (232 vs 196 min, p = 0.055) and in those undergoing THA-R compared to THA (256 vs 182 min <0.001). The length of hospitalization for those with AKI was 5.1 vs. 4.3 days for those without AKI (p = 0.2). There was no significant difference between vasopressors use, blood loss, need for transfusion, crystalloid or colloid administration between the AKI and Non-AKI groups. At one year, mean change in eGFR was not different between the two groups (AKI: -1.7 ml/min; Non-AKI: -2.6 ml/min; p = 0.7).

Conclusion

The incidence of AKI after total hip arthroplasty in KTx was 10.4% (17% after revision arthroplasty) and associated with longer hospitalization. However, all cases of AKI were mild, resolved by hospital discharge and did not affect allograft function at 1 year.