Acute kidney injury after primary total hip replacement

Abstract

Surgical interventions that do not directly affect the urinary system can cause excretory dysfunction of kidneys. The aim. To establish the prevalence, risk factors and clinical significance of acute kidney injury after primary hip replacement performed in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology. Materials and methods. We carried out a retrospective analysis of the case histories of 109 patients who underwent primary total hip replacement under conditions of subarachnoid anesthesia in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology in 2021. Results. Postoperative changes in serum creatinine in 8 patients of the study group met the KDIGO (The Kidney Disease: Improving Global Outcomes) criteria for acute kidney injury. Initial indicators of renal excretory function in the subgroup with acute kidney injury were not different from those in the entire group. Statistically significant correlation was established between acute kidney injury and indicators of oxygen-carrying capacity of blood – initial and minimal postoperative hemoglobin concentration. Acute kidney injury in patients of the study group had a minimal effect on the clinical course of the early postoperative period. None of the patients required renal replacement therapy, re-transfer from the specialized unit to the intensive care unit or any specific treatment. The duration of postoperative stay of patients with acute kidney injury in the clinic did not increase. Conclusions. Acute kidney injury was detected in 7.3  % of patients who underwent primary total hip replacement. Risk factors for the development of postoperative acute kidney injury in  patients of the study group included relatively low initial and  minimal postoperative blood hemoglobin concentrations, which may indicate prerenal mechanism of acute kidney injury pathogenesis. Implementation of the main steps of the “renal protocol” in patients with initial glomerular filtration rate over 45 ml/min/1.73 m2 allows avoiding the development of severe clinically significant forms of postoperative acute kidney injury and complications associated with it in the early postoperative period of primary total hip replacement.