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. 2021 May 1;11(5):822.
doi: 10.3390/diagnostics11050822.

Chronic Kidney Disease Is Associated with High Mortality Risk in Patients with Diabetes after Primary Shoulder Arthroplasty: A Nationwide Population-Based Cohort Study

Meng-Hao Lin  1 , Su-Ju Lin  2 , Liang-Tseng Kuo  3   4 , Tien-Hsing Chen  4   5 , Chi-Lung Chen  5 , Pei-An Yu  5 , Yao-Hung Tsai  5 , Wei-Hsiu Hsu  3   4
Affiliations

Chronic Kidney Disease Is Associated with High Mortality Risk in Patients with Diabetes after Primary Shoulder Arthroplasty: A Nationwide Population-Based Cohort Study

Meng-Hao Lin et al. Diagnostics (Basel). .

Abstract

The number of diabetic patients with chronic kidney disease (CKD) undergoing shoulder arthroplasty is growing. This study aims to compare perioperative outcomes of shoulder arthroplasty in diabetic patients at different renal function stages. Between 1998 and 2013, a total of 4443 diabetic patients with shoulder arthroplasty were enrolled: 1174 (26%) had CKD without dialysis (CKD group), 427 (9%) underwent dialysis (dialysis group), and 3042 (68%) had no CKD (non-CKD group). Compared with the non-CKD group, the CKD (odds ratio [OR], 4.69; 95% confidence interval [CI], 2.02-10.89) and dialysis (OR, 6.71; 95% CI, 1.63-27.73) groups had a high risk of in-hospital death. The dialysis group had a high risk of infection after shoulder arthroplasty compared with the CKD (subdistribution hazard ratio [SHR], 1.69; 95% CI, 1.07-2.69) and non-CKD (SHR, 1.76; 95% CI, 1.14-2.73) groups. The dialysis group showed higher risks of all-cause readmission and mortality than the CKD and non-CKD groups after a 3-month follow-up. In conclusion, CKD was associated with worse outcomes after shoulder arthroplasty. Compared with those without CKD, CKD patients had significantly increased readmission and mortality risks but did not have an increased risk of surgical complications, including superficial infection or implant removal.

Keywords: chronic kidney disease; diabetes mellitus; dialysis; mortality; readmission; shoulder arthroplasty.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for patient inclusion.
Figure 2
Figure 2
Distribution of renal function status for patients with diabetes who received shoulder arthroplasty from 1998 to 2013. The proportion of patients with non-dialysis CKD and those requiring dialysis stably increased across the study period (p-trend < 0.001). CKD, chronic kidney disease.
Figure 3
Figure 3
Adjusted cumulative incidence of (a) postoperative infection and (b) all-cause readmission. (c) Adjusted survival rate of all-cause mortality in patients with diabetes having different renal function statuses. CKD, chronic kidney disease.
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