AKI Following Arthroplasty in Transplant Recipients

Boston—Secondary bone complications such as avascular necrosis/osteoporosis are common among transplant recipients. Arthroplasty is the usual treatment of choice. However, acute kidney injury (AKI) often occurs during total arthroplasty, with incidence rates among transplant recipients from 16% to 26%; incidence rates in the general population are as low as 1.1%. There are few data on the underlying reasons why kidney transplant recipients are at increased risk for AKI; the long-term consequences are also unknown. Sorkko Thirunavukkarasu, MD, and Ziad El-Zoghby, MD, of the Mayo Clinic, Rochester, Minnesota, recently conducted a retrospective review of 106 kidney transplant recipients who underwent total hip arthroplasty at the Mayo Clinic between 2000 and 2018. Results of the review were reported during a poster session at the NKF Spring Clinical Meetings in a poster titled Acute Kidney Injury (AKI) in Kidney Transplant Recipients (KTS) Undergoing Total Hip Arthroplasty (THA). Chart review was used to obtain demographic data and clinical information. Current Kidney Disease Improving Global Outcomes criteria were used to define AKI using serial creatinine values prior to surgery (baseline) and within 1 week of surgery. Data on length of stay, exposure to angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and nonsteroidal anti-inflammatory drugs (NSAIDs), and, to assess long-term effects on allograft function, creatinine levels at 1 year after surgery were also collected. At the time of surgery, average age was 59 years; 57% of the cohort were male, and 95% were white. The surgical indications were degenerative joint disease (57%), avascular necrosis (28%), fractures (12%), and miscellaneous (3%). AKI occurred in 11 patients (11%). All were stage 1 per Acute Kidney Injury Network criteria. The cause of AKI was unclear in six patients, three were diagnosed with acute tubular necrosis, and two were presumed to be due to pre-renal etiology. None of the total cohort received ACE/ARBs the day of surgery; two patients received NSAIDs postoperatively, but did not develop AKI. Among the AKI patients, 81% (9/11) had creatinine level return to baseline at discharge. The average length of stay for the patients with AKI was 5.3 days compared with 3.7 days for those who did not develop AKI. There were no differences between the two groups in change in estimated glomerular filtration rate at 1 year post-surgery. “The incidence in AKI in kidney transplant recipients after total hip arthroplasty was 11% with recovery to baseline in almost all patients and no difference in allograft function at 1 year,” the researchers said. Source: Thirunavukkarasu S, El-Zoghby Z. Acute kidney injury (AKI) in kidney transplant recipients (KTR) undergoing total hip arthroplasty (THA). Abstract of a poster presented at the National Kidney Foundation 2019 Spring Clinical Meetings, May 8-12, 2019, Boston, Massachusetts.