Investigation of acute kidney injury risk factors in patients undergoing total joint arthroplasty

"Investigation of Acute Kidney Injury Risk Factors in Patients Undergoing Total Joint Arthroplasty" Aim: The primary aim of this study is to determine the risk factors associated with postoperative acute kidney injury in patients undergoing total joint arthroplasty. Considering that this patient group is mostly composed of advanced age and comorbid patients, the secondary aim of the study is to identify risky patients with predictable risk factors and to chart a way to make preoperative optimizations of these patients before they develop postoperative complications. Materials and Methods: Patients who underwent joint arthroplasty between 2015 and 2020 in Ankara University Faculty of Medicine, Department of Orthopedics and Traumatology were included. Within the scope of the study, patients' gender, age, weight, height, body mass index values, smoking, American Society of Anesthesiologist (ASA) score, Charlson-Comorbidity Index score (CCI), type of operation, duration of surgery, presence of intraoperative hypotension, anesthesia method , diabetes, hypertension, coronary artery disease, presence of congestive heart failure, presence of preoperative anemia, preoperative uric acid and albumin level, use of nephrotoxic agents in the perioperative period, basal creatinine and glomerular filtration rate (GFR) values, platelet suspension in the perioperative period, erythrocyte suspension, Amounts of fresh frozen plasma transfusions, postoperative creatinine at 24 hours - 48 hours - discharge, GFR values and Kidney Disesae Improving Global Outcomes (KDIGO) scores, length of hospital stay and length of stay in the intensive care unit were evaluated. Results: The study was initiated with 1781 patients, 113 patients were excluded due to chronic kidney failure, 108 patients were due to acute kidney failure, 648 patients were excluded because their data could not be reached, and 912 patients were included in the study. As a result of the study, the development of acute kidney injury (AKI) was detected in 134 patients (14.6%). Risk factors affecting AKI were examined, advanced age, ASA, CCI, presence of diabetes and hypertension, nonsteroidal anti-inflammatory drugs (NSAID), vancomycin, contrast material use and preoperative anemia were found to be significant risk factors (p<0.05). ). In demographic data, significant differences were found between groups with and without AKI for age, CCI, ASA, and type of operation (p<0.001, p<0.001, p<0.001 and p=0.002, respectively). Differences were evaluated in terms of comorbidity and drugs, and a significant difference was found between the two groups for diabetes, hypertension, vancomycin, contrast material use, and preoperative anemia (p=0.003, p<0.001, p<0.001, p<0.001 and p=0.014), respectively. . Differences were examined in terms of variables, and a significant difference was found between the two groups in terms of preoperative albumin level, basal GFR, erythrocyte suspension transfusion and hospitalization time (p<0.05). Conclusion: As a result of our study, advanced age, high ASA and CCI scores, presence of diabetes and hypertension, use of NSAIDs, vancomycin and contrast material, and presence of preoperative anemia were revealed as independent risk factors by univariate logistic regression analysis. Keywords: postoperative AKI, arthroplasty, comorbidity, anemia