Acute renal impairment after primary total knee replacements: a retrospective analysis

Abstract

INTRODUCTION: Acute renal impairment (ARI) after primary total knee replacement (TKR) has been reported to be uncommon (incidence 0.55%) but may increase morbidity and mortality. Our study aimed at investigating the local incidence of and predisposing factors for ARI after TKR. MATERIALS AND METHODS: Patients who met the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease) classification for ARI after receiving TKRs in our institution between 1 January 2013 and 3 March 2015 were retrospectively identified by the Clinical Data Analysis and Reporting System and review of medical records. Demographic and perioperative data were analysed. RESULTS: A total of 705 patients received TKRs (594 unilateral vs. 111 1-stage bilateral TKRs). The incidence of ARI was 2.55% (n=18). Patients having 1-stage bilateral TKRs (6.3% vs. 1.3% unilateral TKR cases) and patients taking angiotensin-converting enzyme inhibitors / angiotensin II receptor blockers (ACEI / ARB) [4.7% vs. 1.5% patients not taking either ACEI / ARB] had statistically significantly higher risk of ARI (p<0.05). Furthermore, 61% (11/18) patients had hypotensive episodes (systolic blood pressure <100 mm Hg) in the early postoperative period. All patients with ARI were managed conservatively but 1 patient required intensive care unit admission for monitoring without the need for renal replacement therapy. DISCUSSION AND CONCLUSION: Our incidence of ARI was 2.55%. The most significant risk factors were the use of ACEI / ARB and 1-stage bilateral TKRs. Precautions should be taken for these at-risk groups preoperatively to prevent ARI.