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Early postoperative albumin level following total knee arthroplasty is associated with acute kidney injury: A retrospective analysis of 1309 consecutive patients based on kidney disease improving global outcomes criteria.

Kim HJ, Koh WU, Kim SG, Park HS, Song JG, Ro YJ, Yang HS - Medicine (Baltimore) (2016)

Bottom Line: A comparison of incidence of AKI, hospital stay, and overall mortality in the 2 groups was performed using propensity score analysis.Of 1309 patients, 57 (4.4%) developed AKI based on Kidney Disease Improving Global Outcomes criteria.Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65-5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26-1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48-4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08-87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09-3.37; P = 0.023).After propensity score analysis, POD2_alb level<3.0 g/dL was associated with AKI occurrence (OR 1.82; 95% CI 1.03-3.24, P = 0.041) and longer hospital stay (P = 0.001).In this study, we demonstrated that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and lengthened hospital stay in patients undergoing TKA.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Hypoalbuminemia has been reported to be an independent risk factor for acute kidney injury (AKI). However, little is known about the relationship between the albumin level and the incidence of AKI in patients undergoing total knee arthroplasty (TKA). The aim of our study was to assess incidence and risk factors for AKI and to evaluate the relationship between albumin level and AKI following TKA.The study included a retrospective review of medical records of 1309 consecutive patients who underwent TKA between January 2008 and December 2014. The patients were divided into 2 groups according to the lowest serum albumin level within 2 postoperative days (POD2_alb level < 3.0 g/dL vs ≥3.0 g/dL). Multivariate logistic regression analysis was used to assess risk factors for AKI. A comparison of incidence of AKI, hospital stay, and overall mortality in the 2 groups was performed using propensity score analysis.Of 1309 patients, 57 (4.4%) developed AKI based on Kidney Disease Improving Global Outcomes criteria. Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65-5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26-1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48-4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08-87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09-3.37; P = 0.023). After propensity score analysis, POD2_alb level<3.0 g/dL was associated with AKI occurrence (OR 1.82; 95% CI 1.03-3.24, P = 0.041) and longer hospital stay (P = 0.001).In this study, we demonstrated that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and lengthened hospital stay in patients undergoing TKA.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier survival curve. The survival rate of patients with acute kidney injury was significantly lower than in those without acute kidney injury (log-rank test, P < 0.001).
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Figure 2: Kaplan–Meier survival curve. The survival rate of patients with acute kidney injury was significantly lower than in those without acute kidney injury (log-rank test, P < 0.001).

Mentions: The intergroup differences of postoperative outcomes stratified by the POD2_alb level are shown in Table 4. Crude (univariate) analysis indicated that the POD2_alb level < 3.0 g/dL was related with the occurrence of AKI (OR, 1.77; 95% CI, 1.04–3.01; P = 0.036). The hospital stay was longer in patients with POD2_alb level < 3.0 g/dL than that of the POD2_alb level ≥ 3.0 g/dL group (16.6 ± 5.6 days vs 16.0 ± 4.2 days, respectively, P = 0.024). After IPTW adjustment, the POD2_alb level < 3.0 g/dL was also associated with AKI (OR, 1.82; 95% CI, 1.03–3.24; P = 0.041) and longer hospital stay than POD2_alb level ≥ 3.0 g/dL (16.7 ± 5.5 days vs 15.9 ± 4.2 days, respectively, P = 0.001). The Kaplan–Meier survival curve demonstrated that the incidence of overall mortality was higher in patients with AKI than in those without AKI (log-rank test, P < 0.001, Fig. 2). However, no correlation was found between POD2_alb level < 3.0 g/dL and overall mortality after IPTW adjustment in patients who underwent TKA (HR, 0.99; 95% CI 0.58–1.68; P = 0.973).


Early postoperative albumin level following total knee arthroplasty is associated with acute kidney injury: A retrospective analysis of 1309 consecutive patients based on kidney disease improving global outcomes criteria.

Kim HJ, Koh WU, Kim SG, Park HS, Song JG, Ro YJ, Yang HS - Medicine (Baltimore) (2016)

Kaplan–Meier survival curve. The survival rate of patients with acute kidney injury was significantly lower than in those without acute kidney injury (log-rank test, P < 0.001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979848&req=5

Figure 2: Kaplan–Meier survival curve. The survival rate of patients with acute kidney injury was significantly lower than in those without acute kidney injury (log-rank test, P < 0.001).
Mentions: The intergroup differences of postoperative outcomes stratified by the POD2_alb level are shown in Table 4. Crude (univariate) analysis indicated that the POD2_alb level < 3.0 g/dL was related with the occurrence of AKI (OR, 1.77; 95% CI, 1.04–3.01; P = 0.036). The hospital stay was longer in patients with POD2_alb level < 3.0 g/dL than that of the POD2_alb level ≥ 3.0 g/dL group (16.6 ± 5.6 days vs 16.0 ± 4.2 days, respectively, P = 0.024). After IPTW adjustment, the POD2_alb level < 3.0 g/dL was also associated with AKI (OR, 1.82; 95% CI, 1.03–3.24; P = 0.041) and longer hospital stay than POD2_alb level ≥ 3.0 g/dL (16.7 ± 5.5 days vs 15.9 ± 4.2 days, respectively, P = 0.001). The Kaplan–Meier survival curve demonstrated that the incidence of overall mortality was higher in patients with AKI than in those without AKI (log-rank test, P < 0.001, Fig. 2). However, no correlation was found between POD2_alb level < 3.0 g/dL and overall mortality after IPTW adjustment in patients who underwent TKA (HR, 0.99; 95% CI 0.58–1.68; P = 0.973).

Bottom Line: A comparison of incidence of AKI, hospital stay, and overall mortality in the 2 groups was performed using propensity score analysis.Of 1309 patients, 57 (4.4%) developed AKI based on Kidney Disease Improving Global Outcomes criteria.Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65-5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26-1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48-4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08-87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09-3.37; P = 0.023).After propensity score analysis, POD2_alb level<3.0 g/dL was associated with AKI occurrence (OR 1.82; 95% CI 1.03-3.24, P = 0.041) and longer hospital stay (P = 0.001).In this study, we demonstrated that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and lengthened hospital stay in patients undergoing TKA.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Hypoalbuminemia has been reported to be an independent risk factor for acute kidney injury (AKI). However, little is known about the relationship between the albumin level and the incidence of AKI in patients undergoing total knee arthroplasty (TKA). The aim of our study was to assess incidence and risk factors for AKI and to evaluate the relationship between albumin level and AKI following TKA.The study included a retrospective review of medical records of 1309 consecutive patients who underwent TKA between January 2008 and December 2014. The patients were divided into 2 groups according to the lowest serum albumin level within 2 postoperative days (POD2_alb level < 3.0 g/dL vs ≥3.0 g/dL). Multivariate logistic regression analysis was used to assess risk factors for AKI. A comparison of incidence of AKI, hospital stay, and overall mortality in the 2 groups was performed using propensity score analysis.Of 1309 patients, 57 (4.4%) developed AKI based on Kidney Disease Improving Global Outcomes criteria. Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65-5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26-1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48-4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08-87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09-3.37; P = 0.023). After propensity score analysis, POD2_alb level<3.0 g/dL was associated with AKI occurrence (OR 1.82; 95% CI 1.03-3.24, P = 0.041) and longer hospital stay (P = 0.001).In this study, we demonstrated that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and lengthened hospital stay in patients undergoing TKA.

No MeSH data available.


Related in: MedlinePlus