Track topics on Twitter Track topics that are important to you
Background: Reduced estimated glomerular filtration rate (eGFR) is strongly associated with increased cardiovascular risk and all-cause mortality. Associations with morbidity in elective, moderate-risk noncardiac surgery have not been explored. We hypothesized that chronic kidney disease (CKD) would be associated with excess morbidity after elective, moderate-risk orthopedic surgery. Methods: Patients undergoing elective orthopedic joint replacement procedures were studied, representing a large proportion of global surgical procedures and characterized by highly homogeneous anesthetic and surgical practice. eGFR was calculated from routine creatinine measurements using the Modification of Diet in Renal Disease equation. CKD was defined as eGFR <60 mL/min/1.73 m(2). Cardiac risk (Revised Cardiac Risk Index) and evidence-based, perioperative factors associated with perioperative morbidity (operative time, blood loss, perioperative temperature) were also recorded prospectively. The primary end point was postoperative morbidity, recorded prospectively using the postoperative morbidity survey. Morbidity differences were analyzed between patients with CKD and normal preoperative renal function (chi(2) test for trend) and presented as hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (95% CIs). The secondary end points were time to hospital discharge and time to become morbidity free (analyzed by log-rank test), both between and within CKD compared with normal renal function patients. Multiple regression analysis was performed to assess the association of CKD, perioperative factors with morbidity, and length of hospital stay. Results: Postoperative morbidity survey was recorded in 526 patients undergoing elective orthopedic surgery. CKD patients (n = 142; 27%) sustained excess morbidity on postoperative day 5 (OR 2.1 [95%
1.2-3.7]; P < 0.0001). CKD patients took longer (HR 1.6 [95%
1.2-1.9]) to become morbidity free (log-rank test, P < 0.0001). Time to hospital discharge was delayed by 4 days in CKD patients (HR 1.4 [95%
1.2-1.7]; P = 0.0001; log-rank test). CKD patients sustained more pulmonary (OR 2.2 [95%
1.3-3.6]; P = 0.002), infectious (OR 1.7 [95%
1.1-2.7]; P = 0.01), cardiovascular (OR 2.4 [95%
1.2-4.8]; P = 0.01), renal (OR 2.3 [95%
1.5-3.5]; P < 0.00,001), neurological (OR 4.3 [95%
1.3-17.7]; P = 0.005), and pain (OR 1.8 [95%
1.03-3.1]; P = 0.04) morbidities. Further stratification of CKD revealed preoperative eGFR =50 mL/min/1.73 m(2) to be associated with more frequent morbidity and longer hospital stay, independent of age. Multiple regression analysis identified CKD (P = 0.006) and congestive cardiac failure (P = 0.002) as preoperative factors associated with prolonged hospital stay. Conclusions: A substantial minority of patients with CKD undergoing elective orthopedic procedures are at increased risk of prolonged morbidity and hospital stay. Preoperative eGFR may enhance perioperative risk stratification beyond traditional risk factors.
From the *Department of Medicine, Wolfson Institute for Biomedical Research, University College London;
This article was published in the following journal.
Name: Anesthesia and analgesia
Over the past decade, there has been a marked increase in the number of primary and revision total hip and knee arthroplasties performed in the United States. Acute kidney injury (AKI) is a common com...
The goal of elective orthopedic surgery is to return patients to their expected level of activity without an increased incidence of postoperative complications. The first step is identifying patient a...
Aberrant mineral metabolism and bone diseases, which are commonly seen in chronic kidney disease (CKD), have been considered to be the important causes of morbidity and decreased quality of life.
Timely referral is essential in patients with end-stage renal disease. Time is needed to inform the patient on the options of dialysis or kidney transplantation and for the placement of arteriovenous ...
Chronic kidney disease (CKD) Stage 4 is on the path to kidney failure, but there is little information on the risks associated with progression to Stage 4 per se. The objective of this study is to det...
This study will compare repeated intermittent IV dosing of diclofenac in patient with moderate to severe post-surgical pain from elective orthopedic surgery.
Chronic kidney disease, which affects an estimated 300,000 people in Ireland and over 50 million people in the developed world, is responsible for a considerable burden of premature mortal...
Multiple-center, multiple-dose, randomized, double-blind, six-arm, active- and placebo-controlled study in patients with moderate to severe post-surgical pain from elective orthopedic surg...
To investigate the effects of paricalcitol capsules on changes on cardiac structure and function in subjects with Stage 3/4 Chronic Kidney Disease who have left ventricular hypertrophy
Postoperative arrhythmias (heart irregularities) are one of the most common complications after cardiac surgery and are associated with increased morbidity and mortality. Preoperative depr...
Conditions in which the KIDNEYS perform below the normal level for more than three months. Chronic kidney insufficiency is classified by five stages according to the decline in GLOMERULAR FILTRATION RATE and the degree of kidney damage (as measured by the level of PROTEINURIA). The most severe form is the end-stage renal disease (CHRONIC KIDNEY FAILURE). (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002)
The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION.
Surgery which could be postponed or not done at all without danger to the patient. Elective surgery includes procedures to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risk to patients, e.g., cosmetic or contraceptive surgery.
Abnormal enlargement or swelling of a KIDNEY due to dilation of the KIDNEY CALICES and the KIDNEY PELVIS. It is often associated with obstruction of the URETER or chronic kidney diseases that prevents normal drainage of urine into the URINARY BLADDER.
A severe irreversible decline in the ability of kidneys to remove wastes, concentrate URINE, and maintain ELECTROLYTE BALANCE; BLOOD PRESSURE; and CALCIUM metabolism. Renal failure, either acute (KIDNEY FAILURE, ACUTE) or chronic (KIDNEY FAILURE, CHRONIC), requires HEMODIALYSIS.
Nephrology - kidney function
Nephrology is a specialty of medicine and pediatrics that concerns itself with the study of normal kidney function, kidney problems, the treatment of kidney problems and renal replacement therapy (dialysis and kidney transplantation). Systemic conditions...
Arthroplasty Joint Disorders Orthopedics Spinal Cord Disorders Orthopedics is the science or practice of correcting deformities caused by disease or damage to the bones and joints of the skeleton. This specialized branch of surgery may ...