Incidence, associated factors, and outcomes of acute kidney injury following placement of antibiotic bone cement spacers in two-stage exchange for periprosthetic joint infection: a comprehensive study

Frontiers in Cellular and Infection Microbiology

Cellular and Infection Microbiology

Zulipikaer Maimaiti¹  Jun Fu²  Chi Xu²  Zhi-Yuan Li²  Li-Bo Hao²  Zhuo Li³  Fan Yang³  Ji-Ying Chen⁴ 

[1] Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China;Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China;Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China;School of Medicine, Nankai University, Tianjin, China;Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China;School of Medicine, Nankai University, Tianjin, China;Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China;Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China;

关键词: periprosthetic joint infection;    antibiotic bone cement spacer;    acute kidney injury;    incidence;    associated factors;    outcome;   

DOI  :  10.3389/fcimb.2023.1243290

 received in 2023-06-20, accepted in 2023-08-23,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundTwo-stage exchange with placement of antibiotic cement spacer (ACS) is the gold standard for the treatment of chronic periprosthetic joint infection (PJI), but it could cause a high prevalence of acute kidney injury (AKI). However, the results of the current evidence on this topic are too mixed to effectively guide clinical practice.MethodsWe retrospectively identified 340 chronic PJI patients who underwent the first-stage exchange with placement of ACS. The Kidney Disease Improving Global Outcomes guideline was used to define postoperative AKI. Multivariate logistic analysis was performed to determine the potential factors associated with AKI. Furthermore, a systematic review and meta-analysis on this topic were conducted to summarize the knowledge in the current literature further.ResultsIn our cohort, the incidence of AKI following first-stage exchange was 12.1%. Older age (per 10 years, OR= 1.509) and preoperative hypoalbuminemia (OR= 3.593) were independent predictors for postoperative AKI. Eight AKI patients progressed to chronic kidney disease after 90 days. A meta-analysis including a total of 2525 PJI patients showed the incidence of AKI was 16.6%, and AKI requiring acute dialysis was 1.4%. Besides, host characteristics, poor baseline liver function, factors contributing to acute renal blood flow injury, and the use of nephrotoxic drugs may be associated with the development of AKI. However, only a few studies supported an association between antibiotic dose and AKI.ConclusionAKI occurs in approximately one out of every six PJI patients undergoing first-stage exchange. The pathogenesis of AKI is multifactorial, with hypoalbuminemia could be an overlooked associated factor. Although the need for acute dialysis is uncommon, the fact that some AKI patients will develop CKD still needs to be taken into consideration.

【 授权许可】

Unknown   
Copyright © 2023 Li, Maimaiti, Yang, Fu, Li, Hao, Chen and Xu