Study examines acute kidney injury after two-stage exchange for prosthetic joint infection
Risk of acute kidney injury was greater in patients with preexisting chronic kidney disease than those without after two-stage exchange arthroplasty with a high-dose antibiotic-loaded bone cement spacer, according to results.
From 2000 to 2017, investigators at the Mayo Clinic in Rochester, Minnesota, analyzed 424 patients treated with 455 high-dose antibiotic-loaded bone cement (ALBC) spacers after resection of a periprosthetic joint infection (PJI) following primary total knee arthroplasty. According to the study, 15% of patients had preexisting chronic kidney disease (CKD).
Researchers found 54 acute kidney injuries (AKIs) occurred in 52 (14%) of the 359 patients without preexisting CKD and 32 AKIs occurred in 29 (45%) of the 65 patients with CKD – a fivefold increase in risk for those with preexisting CKD, the researchers wrote in the study.
“Overall, when the vancomycin concentration or aminoglycoside concentration was greater than 3.6 grams per batch of cement, the risk of AKI increased,” they added. “Hypertension, perioperative hypovolemia and acute atrial brillation were independent predictors for AKI in patients without preexisting CKD.”
At final follow-up (mean: 6 years; range: 2-17 years), researchers noted eight patients with AKI progressed to CKD, four of whom received dialysis.
“The main concern with an AKI is the progression to CKD,” the researchers concluded. “In our study, the largest series to date that we are aware of from a single institution regarding this issue, we found that a two-stage exchange protocol with ALBC spacers and systemic antibiotics for PJIs after TKA carried a substantial risk of AKI.”