Prevalence and Risk Factors of Post- operative Acute Kidney Injury (AKI) After Hip and Knee Arthroplasty: Systematic Review and Meta-Analysis

Abstract

Background: Acute Kidney Injury (AKI) following surgeries, particularly after hip or knee arthroplasty, presents potential complications, with varying degrees of reported prevalence and associated risk factors. Thus, this systematic review and meta-analysis aimed to estimate the prevalence of Postoperative Acute Kidney Injury (PO-AKI) in patients undergoing hip or knee arthroplasty and identify both modifiable and non-modifiable risk factors. Method: An exhaustive search was conducted using the PubMed database to identify studies that reported the prevalence of PO-AKI in patients undergoing hip or knee arthroplasty. Data extraction focused on the prevalence rate of PO-AKI, associated risk factors, and patient outcomes. The quality of studies was assessed, and meta-analytic techniques were applied to synthesize the findings. Result: The assembled data indicated a PO-AKI prevalence of 6.0% in patients post hip or knee arthroplasty. Several non-modifiable risk factors were identified, including age, male gender, BMI, elevated ASA score, diabetes, cardiovascular disease (CVD), hypertension, and a history of smoking. On the other hand, modifiable risk factors encompassed the use of specific medications, the volume of intraoperative fluids, blood transfusions, as well as pre-operative levels of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR). Moreover, post-operative variations in haemoglobin (Hb) and albumin (Alb) were recognized as strong predictors of PO-AKI development. Importantly, AKI's occurrence post-surgery was linked with adverse patient outcomes such as extended hospitalization, elevated mortality rates, and an increased number of intensive care unit admissions. Conclusion: This study emphasizes that PO-AKI is a notable complication in hip and knee arthroplasty, influenced by various modifiable and non-modifiable risk factors. The association of PO-AKI with adverse patient outcomes highlights the need for improved risk stratification and preventative strategies in this population. However, the diverse findings across studies indicate a necessity for further research to consolidate these insights.