Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

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.

Keywords: acute kidney injury; acute renal failure; epidemiology; hip Surgery; hip arthroplasty; incidence; meta-analysis; postoperative acute kidney injury; systematic reviews.

Figure 1

Outline of our search methodology.

Figure 2

Forest plots of the included studies [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] assessing (A) incidence rates of AKI and (B) incidence rates of AKI requiring dialysis following THA. A diamond data marker represents the overall rate from each included study (square data marker) and 95% confidence interval (CI).

Figure 3

Meta-regression analyses showed significant negative correlation between incidence of AKI following THA and the study year (slope = −0.37, p <0.001). The solid black line represents the weighted regression line based on variance-weighted least squares. The inner and outer lines show the 95% confidence interval and prediction interval around the regression line. The circles indicate log event rates in each study.