Abstract
Background: The number of total hip arthroplasties (THA) performed across the world is growing rapidly. We performed this meta-analysis to evaluate the incidence of acute kidney injury (AKI) in patients undergoing THA. Methods: A literature search was performed using MEDLINE, EMBASE and Cochrane Database from inception until July 2018 to identify studies assessing the incidence of AKI (using standard AKI definitions of RIFLE, AKIN, and KDIGO classifications) in patients undergoing THA. We applied a random-effects model to estimate the incidence of AKI. The protocol for this meta-analysis is registered with PROSPERO (no. CRD42018101928). Results: Seventeen cohort studies with a total of 24,158 patients undergoing THA were enrolled. Overall, the pooled estimated incidence rates of AKI and severe AKI requiring dialysis following THA were 6.3% (95% CI: 3.8%–10.2%) and 0.5% (95% CI: 0.1%–2.3%). Subgroup analysis based on the countries by continent was performed and demonstrated the pooled estimated incidence of AKI following THA of 9.2% (95% CI: 5.6%–14.8%) in Asia, 8.1% (95% CI: 4.9%–13.2%) in Australia, 7.4% (95% CI: 3.2%–16.3%) in Europe, and 2.8% (95% CI: 1.2%–17.0%) in North America. Meta-regression of all included studies showed significant negative correlation between incidence of AKI following THA and study year (slope = −0.37, p <0.001). There was no publication bias as assessed by the funnel plot and Egger’s regression asymmetry test with p = 0.13 for the incidence of AKI in patients undergoing THA. Conclusion: The overall estimated incidence rates of AKI and severe AKI requiring dialysis in patients undergoing THA are 6.3% and 0.5%, respectively. There has been potential improvement in AKI incidence for patients undergoing THA over time.
Highlights
Acute kidney injury (AKI) is a complex clinical syndrome, characterized by an abrupt decrease in glomerular filtration, associated with various etiologies and pathophysiological pathways [1,2,3,4,5,6].Globally, acute kidney injury (AKI) is a common condition, affecting 13.3 million patients a year [3,4]
Subgroup analysis based on the countries by continent was performed and demonstrated pooled estimated incidence of AKI following total hip arthroplasties (THA) of 9.2% in Asia, 8.1%
In this systematic review and meta-analysis, we found that patients who underwent THA had incidences of AKI and AKI requiring dialysis of 6.3% and 0.5%, respectively
Summary
Acute kidney injury (AKI) is a complex clinical syndrome, characterized by an abrupt decrease in glomerular filtration, associated with various etiologies and pathophysiological pathways [1,2,3,4,5,6]. AKI is a common condition, affecting 13.3 million patients a year [3,4] This complex syndrome is associated with significant morbidity, considerable mortality resulting in 1.7 million deaths a year, and increased hospital costs and subsequent burden on national health care budgets across the world [7,8]. Total hip arthroplasty (THA) is one of the most consistently successful and cost-effective orthopedic procedures performed today. It is indicated in patients with severe hip pain from a variety of conditions and provides significant improved pain relief, functionality and quality of life [9,10,11,12,13,14,15].
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