Link between Renal Toxicity with Resection and Spacer Insert
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The most popular method of treating infected complete hip arthroplasties is two-stage exchange arthroplasty with a high-dose antibiotic-loaded bone cement (ALBC) spacer and intravenous (IV) antibiotics (THAs). The current prevalence, risk factors, and outcomes of acute kidney injuries (AKIs) in this cohort were studied.

Analysis included 227 patients treated with 256 ALBC spacers after resection of an infected primary THA. Mean age was 65 years, mean BMI was 30 mg/kg2, 55% were male, and 16% had pre-existing chronic kidney disease (CKD). Spacers were in situ for a mean of 15 weeks, concomitantly associated with IV or oral antibiotics for a mean of 6 weeks. AKI was defined as a creatinine more than 1.5X baseline or more than 0.3 mg/dL. Mean follow-up was 8 years.

--AKI occurred in 13 patients without pre-existing CKD (7%) versus 10 patients with CKD (28%). None required acute dialysis. Postoperative fluid depletion (beta=0.31), ICU requirement (beta=0.40), and acute atrial fibrillation (beta=0.43) were independent predictors for AKI in patients without pre-existing CKD.

--Duration of in situ spacer, mean antibiotic dose in cement, use of amphotericin B, and type of IV antibiotics were not significant risk factors.

--At last follow-up, 8 AKIs progressed to CKD, with 1 receiving dialysis 7 years later.

Acute kidney injuries (AKIs) is seen in 7% of patients with normal renal function, with a 5-fold higher risk in those with CKD, and 4% of those with normal renal function developed CKD. A significant finding was that the causes of acute renal blood flow deficiency were independent predictors of AKI.