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Kidney Week

Abstract: TH-PO073

Incidence and Risk Factors of AKI After Total Knee Arthroplasty (TKA) or Revision (TKA-R) 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

Kidney transplant recipients have an increased risk of complications following knee arthroplasties and revisions compared to non-transplant patients. The incidence of AKI is reported to be as high as 15.6 % and has been associated with increased mortality, morbidity, and length of hospital stays (LOS). Our AIM was to determine the incidence of AKI in KTx patients undergoing primary knee arthroplasty (TKA) or secondary revision (TKA-R), identify risk factors associated with AKI and evaluate its effect on allograft function at one year.

Methods

Using the orthopedic and transplant databases we designed a case-control study of 82 patients undergoing a total of 101 TKA and knee revisions between 2000 and 2018 at the Mayo Clinic. Information not available through the databases was obtained through chart review. AKI was defined per current KIDGO guidelines.

Results

The average age at surgery was 65 years (range 35-83); with 58% male and 98% white. The most common surgical indication was degenerative joint disease (80%). The incidence of AKI was 7 % in TKA and no patients developed AKI in the TKA-R group. All were stage 1 as per AKIN criteria. The LOS for those with AKI was 4.9 days compared to 3.5 days for those without AKI (p = 0.04). Mean anesthesia time was similar in patients with AKI (170 vs 189 min, p = 0.3). There was no significant difference between pressor requirements, estimated blood loss, need for transfusion, or amount of fluid administered between the AKI and Non-AKI groups. At one year, the mean eGFR change in the AKI group was (- 11.8 ml/min) compared to (-0.9 ml/min) in the Non-AKI group, p=0.065.

Conclusion

The incidence of AKI after total knee arthroplasty in KTx was 7 % and associated with longer hospitalization. All cases of AKI were mild, with renal function improving by hospital discharge. At one year, patients with AKI did have a lower eGFR compared to the non-AKI group but the difference did not reach statistical significance. Further larger studies are needed to assess the effect of TKA on allograft function.