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      Predictors of Acute Kidney Injury After Hip Fracture in Older Adults

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          Abstract

          Introduction:

          This study aimed to investigate the prevalence of acute kidney injury (AKI) following hip fracture surgery in geriatric patients and to identify predictors for development of AKI with a focus on possible preventable risk factors.

          Methods:

          In this retrospective cohort study, we reviewed electronic medical records of all patients above 65 years of age who underwent hip fracture surgery at Copenhagen University Hospital, Bispebjerg, Denmark, in 2018. Acute kidney injury was assessed according to the Kidney Disease Improving Global Outcomes guidelines. Multivariate logistic regression analyses were used to identify independent risk factors for AKI.

          Results:

          Postoperative AKI developed in 28.4% of the included patients (85/299). Acute kidney injury was associated with increased length of admission (11.3 vs 8.7 days, P < .001) and 30-day mortality (18/85 vs 16/214, P = .001). In multivariable analysis, higher age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.08, P = .004), heart disease (OR: 1.78, 95% CI: 1.01-3.11, P = .045), and postoperative blood transfusion (OR: 1.84, 95% CI: 1.01-3.36, P = .048) were associated with AKI. Moreover, a higher postoperative C-reactive protein (199.0 ± 99.9 in patients with AKI, 161.3 ± 75.2 in patients without AKI) and lower postoperative diastolic blood pressure were observed in patients developing AKI.

          Discussion and Conclusion:

          Acute kidney injury was common following hip fracture surgery and associated with longer admissions and increased mortality. Patients developing AKI were older and showed several postoperative similarities, including higher C-reactive protein, lower postoperative diastolic pressure, and the need for blood transfusion.

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          Most cited references32

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          An assessment of the RIFLE criteria for acute renal failure in hospitalized patients.

          Shigehiko Uchino, Rinaldo Bellomo, Donna Goldsmith … (2006)
          The Acute Dialysis Quality Initiative (ADQI) Group published a consensus definition (the RIFLE criteria) for acute renal failure. We sought to assess the ability of the RIFLE criteria to predict mortality in hospital patients. Retrospective single-center study. University-affiliated hospital. All patients admitted to the study hospital between January 2000 and December 2002. Patients were excluded if they were younger than 15 yrs old, were on chronic dialysis, or had kidney transplant or if their length of hospital stay was <24 hrs. None. We included 20,126 patients. Mean age was 64 yrs, 14.7% of patients required intensive care unit admission, and hospital mortality was 8.0%. According to the RIFLE criteria, 9.1% of all patients were in the Risk category for acute renal failure, 5.2% were in the Injury category, and 3.7% were in the Failure category. There was an almost linear increase in hospital mortality from Normal to Failure (Normal, 4.4%; Risk, 15.1%; Injury, 29.2%; and Failure, 41.1%). Multivariate logistic regression analysis showed that all RIFLE criteria were significantly predictive factors for hospital mortality, with an almost linear increase in odds ratios from Risk to Failure (odds ratios, Risk 2.5, Injury 5.4, Failure 10.1). The RIFLE criteria for acute renal failure classified close to 20% of our study patients as having some degrees of acute impairment in renal function and were useful in predicting their hospital mortality.
          Article 0 comments Cited 209 times – based on 0 reviews     Review now
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            Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study.

            Camille J. Roche, R Wenn, Allisyn Moran … (2005)
            To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality. Prospective observational cohort study. University teaching hospital. 2448 consecutive patients admitted with an acute hip fracture over a four year period. We excluded 358 patients: all those aged < 60; those with periprosthetic fractures, pathological fractures, and fractures treated without surgery; and patients who died before surgery. Routine care for hip fractures. Postoperative complications and mortality at 30 days and one year. Mortality was 9.6% at 30 days and 33% at one year. The most common postoperative complications were chest infection (9%) and heart failure (5%). In patients who developed postoperative heart failure mortality was 65% at 30 days (hazard ratio 16.1, 95% confidence interval 12.2 to 21.3). Of these patients, 92% were dead by one year (11.3, 9.1 to 14.0). In patients who developed a postoperative chest infection mortality at 30 days was 43% (8.5, 6.6 to 11.1). Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3 to 2.5), and malignancy (1.5, 1.01 to 2.3). In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor. Chest infection and heart failure are the most common postoperative complications and lead to increased mortality. These groups offer a clear target for specialist medical assessment.
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              Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis.

              Steven Coca, Oyindamola B. Yusuf, A Garg … (2009)
              Acute kidney injury (AKI) is common in hospitalized patients. The impact of AKI on long-term outcomes is controversial. Systematic review and meta-analysis. Persons with AKI. MEDLINE and EMBASE databases were searched from 1985 through October 2007. Original studies describing outcomes of AKI for patients who survived hospital discharge were included. Studies were excluded from review when participants were followed up for less than 6 months. AKI, defined as acute changes in serum creatinine level or acute need for renal replacement therapy. Chronic kidney disease (CKD), cardiovascular disease, and mortality. 48 studies that contained a total of 47,017 participants were reviewed; 15 studies reported long-term data for patients without AKI. The incidence rate of mortality was 8.9 deaths/100 person-years in survivors of AKI and 4.3 deaths/100 patient-years in survivors without AKI (rate ratio [RR], 2.59; 95% confidence interval, 1.97 to 3.42). AKI was associated independently with mortality risk in 6 of 6 studies that performed multivariate adjustment (adjusted RR, 1.6 to 3.9) and with myocardial infarction in 2 of 2 studies (RR, 2.05; 95% confidence interval, 1.61 to 2.61). The incidence rate of CKD after an episode of AKI was 7.8 events/100 patient-years, and the rate of end-stage renal disease was 4.9 events/100 patient-years. The relative risk for CKD and end-stage renal disease after AKI was unattainable because of lack of follow-up of appropriate controls without AKI. The development of AKI, defined as acute changes in serum creatinine level, characterizes hospitalized patients at increased risk of long-term adverse outcomes.
              Article 0 comments Cited 137 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Geriatr Orthop Surg Rehabil
                Journal ID (iso-abbrev): Geriatr Orthop Surg Rehabil
                Journal ID (publisher-id): GOS
                Journal ID (hwp): spgos
                Title: Geriatric Orthopaedic Surgery & Rehabilitation
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 2151-4585
                ISSN (Electronic): 2151-4593
                Publication date (Electronic): 14 April 2020
                Publication date Collection: 2020
                Volume: 11
                Electronic Location Identifier: 2151459320920088
                Affiliations
                [1 ]Department of Geriatric Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
                [2 ]Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
                [3 ]Department of Anesthesiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
                Author notes
                [*]Julie Braüner Christensen, Department of Geriatric Medicine, Bispebjerg and Frederiksberg Hospital, Ebba Lunds vej 44, 2400 Copenhagen, Denmark. Email: julie_brauner@ 123456hotmail.com
                Author information
                https://orcid.org/0000-0001-7827-4499
                Article
                Publisher ID: 10.1177_2151459320920088
                DOI: 10.1177/2151459320920088
                PMC ID: 7160769
                PubMed ID: 32313715
                SO-VID: 0bdc311e-b454-4c27-88b7-537e68b0d8ea
                Copyright © © The Author(s) 2020
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 01 November 2019
                Date revision received : 23 February 2020
                Date accepted : 11 March 2020
                Categories
                Subject: Original Article
                Custom metadata
                cover-date January-December 2020
                typesetter ts3

                Keywords: acute kidney injury,hip fracture,fragility fractures,elderly,blood transfusion,hypotension,old
                Data availability:
                Keywords: acute kidney injury, hip fracture, fragility fractures, elderly, blood transfusion, hypotension, old

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