PDF(Pubmed)
Abstract：
UNASSIGNED: Acute kidney injury (AKI) is associated with increased complications after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to determine the risk factors for AKI after THA and TKA and evaluate if preoperative use of antihypertensive drugs is a risk factor for AKI.
UNASSIGNED: A retrospective review of 7406 primary TKAs and THAs (4532 hips and 2874 knees) from 2013 to 2019 was performed. The following preoperative variables were obtained from medical records: medications, chemistry 7 panel, Elixhauser comorbidities, and demographic factors. AKI was defined as an increase in serum creatinine by 26.4 μmol·L-1. Multivariate analysis was performed to identify the risk factors.
UNASSIGNED: The overall incidence of postoperative AKI was 6.2% (n = 459). Risk factors for postoperative AKI were found to be: chronic kidney disease (odds ratio [OR] = 7.09; 95% confidence interval [CI]: 4.8-9.4), diabetes (OR: 5.03; 95% CI: 2.8-6.06), ≥3 antihypertensive drugs (OR: 4.2; 95% CI: 2.1-6.2), preoperative use of an angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (OR: 3.8; 95% CI: 2.2-5.9), perioperative vancomycin (OR: 2.7; 95% CI: 1.8-4.6), and body mass index >40 kg/m2 (OR: 1.9; 95% CI: 1.3-3.06).
UNASSIGNED: We have identified several modifiable risk factors for AKI that can be optimized prior to an elective THA or TKA. The use of certain antihypertensive agents namely angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and multidrug antihypertensive regimens were found to significantly increase the risk of AKI. Therefore, perioperative management of patients undergoing joint replacement should include medical comanagement with a focus on careful management of antihypertensives.
UNASSIGNED: A retrospective review of 7406 primary TKAs and THAs (4532 hips and 2874 knees) from 2013 to 2019 was performed. The following preoperative variables were obtained from medical records: medications, chemistry 7 panel, Elixhauser comorbidities, and demographic factors. AKI was defined as an increase in serum creatinine by 26.4 μmol·L-1. Multivariate analysis was performed to identify the risk factors.
UNASSIGNED: The overall incidence of postoperative AKI was 6.2% (n = 459). Risk factors for postoperative AKI were found to be: chronic kidney disease (odds ratio [OR] = 7.09; 95% confidence interval [CI]: 4.8-9.4), diabetes (OR: 5.03; 95% CI: 2.8-6.06), ≥3 antihypertensive drugs (OR: 4.2; 95% CI: 2.1-6.2), preoperative use of an angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (OR: 3.8; 95% CI: 2.2-5.9), perioperative vancomycin (OR: 2.7; 95% CI: 1.8-4.6), and body mass index >40 kg/m2 (OR: 1.9; 95% CI: 1.3-3.06).
UNASSIGNED: We have identified several modifiable risk factors for AKI that can be optimized prior to an elective THA or TKA. The use of certain antihypertensive agents namely angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and multidrug antihypertensive regimens were found to significantly increase the risk of AKI. Therefore, perioperative management of patients undergoing joint replacement should include medical comanagement with a focus on careful management of antihypertensives.
摘要：
■急性肾损伤（AKI）与全髋关节置换术（THA）和全膝关节置换术（TKA）后并发症增加有关。这项研究的目的是确定THA和TKA后AKI的危险因素，并评估术前使用抗高血压药物是否是AKI的危险因素。
■对2013年至2019年的7406例主要TKA和THA（4532髋和2874膝）进行了回顾性审查。从医疗记录中获得以下术前变量：药物，化学7面板，Elixhauser合并症,和人口因素。AKI定义为血清肌酐增加26.4μmol·L-1。进行多因素分析以确定危险因素。
■术后AKI的总发生率为6.2%(n=459)。发现术后AKI的危险因素是：慢性肾脏病（比值比[OR]=7.09;95％置信区间[CI]：4.8-9.4）。糖尿病（OR：5.03；95%CI：2.8-6.06），≥3种降压药（OR：4.2；95％CI：2.1-6.2），术前使用血管紧张素受体阻滞剂或血管紧张素转换酶抑制剂(OR:3.8;95%CI:2.2-5.9),围手术期万古霉素（OR：2.7；95％CI：1.8-4.6），体重指数>40kg/m2（OR：1.9；95％CI：1.3-3.06）。
■我们已经确定了几个可改变的AKI风险因素，可以在选择THA或TKA之前进行优化。使用某些抗高血压药，即血管紧张素转换酶抑制剂，血管紧张素受体阻滞剂，研究发现,多药降压方案显著增加AKI的风险.因此,接受关节置换术的患者的围手术期管理应包括医疗管理，重点是抗高血压药的谨慎管理。
■对2013年至2019年的7406例主要TKA和THA（4532髋和2874膝）进行了回顾性审查。从医疗记录中获得以下术前变量：药物，化学7面板，Elixhauser合并症,和人口因素。AKI定义为血清肌酐增加26.4μmol·L-1。进行多因素分析以确定危险因素。
■术后AKI的总发生率为6.2%(n=459)。发现术后AKI的危险因素是：慢性肾脏病（比值比[OR]=7.09;95％置信区间[CI]：4.8-9.4）。糖尿病（OR：5.03；95%CI：2.8-6.06），≥3种降压药（OR：4.2；95％CI：2.1-6.2），术前使用血管紧张素受体阻滞剂或血管紧张素转换酶抑制剂(OR:3.8;95%CI:2.2-5.9),围手术期万古霉素（OR：2.7；95％CI：1.8-4.6），体重指数>40kg/m2（OR：1.9；95％CI：1.3-3.06）。
■我们已经确定了几个可改变的AKI风险因素，可以在选择THA或TKA之前进行优化。使用某些抗高血压药，即血管紧张素转换酶抑制剂，血管紧张素受体阻滞剂，研究发现,多药降压方案显著增加AKI的风险.因此,接受关节置换术的患者的围手术期管理应包括医疗管理，重点是抗高血压药的谨慎管理。
