Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality

Selma Alagöz

Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality

Öz

Abstract

Purpose: Acutekidney injury is a serious complication after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after hip fracture surgery and the impact of acute kidney injury on short and long-term clinical outcomes.

Material and method: A retrospective study was conducted among 238 patients who underwent hip fracture surgery between March 2012 and November 2017. At admission, clinical and biochemical parameters were measured and acute kidney injury defined according to the Acute Kidney Injury Network criteria. The effects of acute kidney injury on short and long-term mortality were investigated.

Results: Of the 238 patients, 47 (19.7%)developed acute kidney injury during hospitalization and 165 (69.3%) died with a mean follow-up of 22.1±19.9 months. Overall mortality was 38.2%, 54.2%, 61.8%, 65.1%, and 68.1% at 1, 2, 3, 4 and 5-years, respectively. The baseline serum creatinine, hemoglobin level, erythrocyte transfusion volume, chronic kidney disease and comorbidities more than onewere independent risk factors for acute kidney injury. Patients with acute kidney injury during hospitalization had significantly higher rates of short and long-term mortality than those without acute kidney injury. After multivariable adjustment, only chronic kidney disease emerged as an independent predictor for acute kidney injury, while congestive heart disease and longer preoperative hospitalization were risk factor for short-term mortality.

Conclusion: Acute kidney injury is a frequent complication in patients undergoing hip fracture surgery and is independently associated with increased short and long-term mortality.

Özet

Amaç: Artmış morbidite ve mortaliteye yol açabilen akut böbrek hasarı, major cerrahi sonrası önemli bir komplikasyondur. Çalışmamızın amacı, kalça kırığı cerrahisi sonrası oluşan böbrek fonksiyon bozukluğu için olası risk faktörlerini ve akut böbrek hasarının kısa ve uzun dönem klinik sonuçlar üzerindeki etkilerini belirlemektir.

Gereç ve yöntem: Mart 2012 - Kasım 2017 tarihleri arasında kalça kırığı ameliyatı geçirmiş 238 hasta, retrospektif olarak incelendi. Başvuru sırasında klinik ve biyokimyasal parametreler ölçüldü ve Acute Kidney Injury Networkkriterlerine göre akut böbrek hasarı tanımlandı. Akut böbrek hasarının kısa ve uzun süreli mortalite üzerindeki etkileri araştırıldı.

Bulgular: 238 hastanın 47'sinde (%19.7) akut böbrek hasarı gelişti ve tüm takip süresince 165 (%69.3) hasta öldü. Ortalama takip süresi 22.1 ± 19.9 aydı. Genel mortalite 1, 2, 3, 4 ve 5. yıllarda sırasıyla %38.2, %54.2, %61.8, %65.1 ve %68.1 idi. Bazal serum kreatinin, hemoglobin düzeyi, eritrosit transfüzyon hacmi, kronik böbrek hastalığı ve birden fazla komorbidite akut böbrek hasarı için bağımsız risk faktörleriydi. Hastanede yatış sırasında akut böbrek hasarı olan hastalar, akut böbrek hasarı olmayanlara göre anlamlı derecede yüksek oranda kısa ve uzun dönem mortaliteye sahipti. Çok değişkenli analize göre, yalnızca kronik böbrek hastalığı, akut böbrek hasarı için bağımsız bir risk belirleyicisi iken; konjestif kalp hastalığı ve daha uzun preoperatif yatış süresi, kısa dönem mortalite için risk faktörleri idi.

Sonuç: Kalça kırığı ameliyatı geçiren hastalarda akut böbrek hasarı sık görülen bir komplikasyondur ve kısa ve uzun dönemde mortalite artışı ile ilişkilidir.

Anahtar Kelimeler

Acute kidney injury,comorbidity,hip fracture,mortality

Kaynakça

1. Adunsky A, Mizrahi EH, Kaplan A, Purits E, Waitzman A, Arad M. Elevated blood urea, independent of glomerular filtration rate (GFR), confers increased risk of adverse functional outcome in elderly hip fracture patients. Arch Gerontol Geriatr. 2011;53(2):174-8. Doi:10.1016/j.archger.2010.08.009
2. Forsen L, Søgaard A, Meyer H, Edna T-H, Kopjar B. Survival after hip fracture: short-and long-term excess mortality according to age and gender. Osteoporos Int. 1999;10: 73-8. PMID: 10501783
3. Talsnes O, Hjelmstedt F, Dahl OE, Pripp AH, Reikerås O. Biochemical lung, liver and kidney markers and early death among elderly following hip fracture. Arch Orthop Trauma Surg. 2012;132:1753-58. Doi:10.1007/s00402-012-1611-7
4. Hagino T, Ochiai S, Watanabe Y, et al. Hyponatremia at admission is associated with in-hospital death in patients with hip fracture. Arch Orthop Trauma Surg. 2013;133:507-11. Doi:10.1007/s00402-013-1693-x
5. Petersen M, Jørgensen H, Hansen K, Duus B. Factors affecting postoperative mortality of patients with displaced femoral neck fracture. Injury. 2006;37:705-11. Doi:10.1016/j.injury.2006.02.046
6. Khan SK, Rushton SP, Courtney M, Gray AC, Deehan DJ. Elderly men with renal dysfunction are most at risk for poor outcome after neck of femur fractures. Age Ageing. 2013;42:76-81. Doi:10.1093/ageing/afs152
7. Chertow GM, Burdick E, Honour M, Bonventre JV, BatesDW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365-70. Doi:10.1681/ASN.2004090740
8. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers T, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med.1999;130(6):461-70. PMID:10075613

9. Ulucay C, Eren Z, Kaspar EC et al. Risk factors for acute kidney injury after hip fracture surgery in the elderly individuals. Geriatr Orthop Surg Rehabil. 2012;3(4):150-6. Doi: 10.1177/2151458512473827
10. Hong SE, Kim TY, Yoo JH et al. Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery. Plos One. 2017; 20;12(4):e0176259. Doi:10.1371/journal.pone.0176259
11. Vanmassenhove J, Vanholder R, Nagler E, Van BiesenW. Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant. 2013;28:254-73. Doi:10.1093/ndt/gfs380
12. Kayatas K, Sahin G, Tepe M, Kaya ZE, Apaydin S, Denmirtunc R. Acute kidney injury in the elderly hospitalized patients. Ren Fail. 2014;36:1273-77. Doi:10.3109/0886022X.2014.934693
13. Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures:A review. World J Orthop. 2014;5:402. Doi:10.5312/wjo.v5.i4.402
14. Bennet SJ, Berry OM, Goddard J, Keating JF. Acute renal dysfunction following hip fracture. Injury. 2010;41:335-38. Doi:10.1016/j.injury.2009.07.009
15. Harty J. Prevention and Management of Acute Kidney Injury. Ulster Med J. 2014;83:149. PMID: 25484464
16. de Geus HR, Betjes MG, Bakker J. Biomarkers for the prediction of acute kidney injury: a narrative review on current status and future challenges. Clin Kidney J. 2012;5:102-8. Doi:10.1093/ckj/sfs008
17. Lewis JR, Hassan SK, Wenn RT, Moran CG. Mortality and serum urea and electrolytes on admission for hip fracture patients. Injury. 2006;37(8):698-704. Doi:10.1016/j.injury.2006.04.121
18. Seyedi HR, Mahdian M, Khosravi G et al. Prediction of Mortality in Hip Fracture Patients: Role of Routine Blood Tests. Arch Bone Jt Surg. 2015; 3:51. PMID: 25692170
19. Anderson S, Eldadah B, Halter JB et al. Acute kidney injury in older adults. J Am Soc Nephrol. 2011;22:28-38. Doi:10.1681/ASN.2010090934
20. Lopez-Martinez C, Tovar-Rivera E, Becerra-Laparra IK, Chavez-Tapia NC. Clinical impact of indirect markers of renal function in elderly patients with hip fracture. Geriatr Orthop Surg Rehabil. 2014;5(3):131-7. Doi:10.1177/2151458514542336.
21. Carson JL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365(26):2453-2462. Doi:10.1056/NEJMoa1012452.
22. Khan MA, Hossain FS, Ahmed I, Muthukumar N, Mohsen A. Predictors of early mortality after hip fracture surgery. Int Orthop. 2013;37:2119–24 Doi:10.1007/s00264-013-2068-1
23. Pioli G, Barone A, Giusti A, et al. Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res. 2006,18:381-87. PMID: 17167302
24. Ireland AW, Kelly PJ, Cumming RG. Risk factor profiles for early and delayed mortality after hip fracture: Analyses of linked Australian Department of Veterans' Affairs databases. Injury. 2015;46(6):1028-35. doi: 10.1016/j.injury.2015.03.006
25. Cameron ID, Chen JS, March LM, et al. Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: a prospective 5-year study. J Bone Miner Res. 2010;25(4):866-72. Doi:10.1359/jbmr.091029

Ayrıntılar

Birincil Dil

İngilizce

Konular

-

Bölüm

Araştırma Makalesi

Yazarlar

Selma Alagöz ^*
Türkiye

Yayımlanma Tarihi

31 Temmuz 2019

Gönderilme Tarihi

5 Şubat 2019

Kabul Tarihi

4 Mayıs 2019

Yayımlandığı Sayı

Yıl 2019 Cilt: 52 Sayı: 2

IZ

https://izlik.org/JA78UW62SU

Kaynak Göster

RIS / Bibtex

APA

Alagöz, S. (2019). Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi, 52(2), 167-173. https://izlik.org/JA78UW62SU

AMA

1.Alagöz S. Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2019;52(2):167-173. https://izlik.org/JA78UW62SU

Chicago

Alagöz, Selma. 2019. “Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality”. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi 52 (2): 167-73. https://izlik.org/JA78UW62SU.

EndNote

Alagöz S (01 Temmuz 2019) Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi 52 2 167–173.

IEEE

[1]S. Alagöz, “Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality”, Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi, c. 52, sy 2, ss. 167–173, Tem. 2019, [çevrimiçi]. Erişim adresi: https://izlik.org/JA78UW62SU

ISNAD

Alagöz, Selma. “Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality”. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi 52/2 (01 Temmuz 2019): 167-173. https://izlik.org/JA78UW62SU.

JAMA

1.Alagöz S. Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2019;52:167–173.

MLA

Alagöz, Selma. “Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality”. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi, c. 52, sy 2, Temmuz 2019, ss. 167-73, https://izlik.org/JA78UW62SU.

Vancouver

1.Selma Alagöz. Acute Kidney Injury After Hip Fracture Surgery and Its Impact on Mortality. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi [Internet]. 01 Temmuz 2019;52(2):167-73. Erişim adresi: https://izlik.org/JA78UW62SU