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Meta-Analysis
. 2023 Sep 20:13:1243290.
doi: 10.3389/fcimb.2023.1243290. eCollection 2023.

Incidence, associated factors, and outcomes of acute kidney injury following placement of antibiotic bone cement spacers in two-stage exchange for periprosthetic joint infection: a comprehensive study

Zhuo Li  1   2 , Zulipikaer Maimaiti  2 , Fan Yang  1   2 , Jun Fu  2   3 , Zhi-Yuan Li  2   3 , Li-Bo Hao  2   3 , Ji-Ying Chen  1   2   3 , Chi Xu  2   3
Affiliations
Meta-Analysis

Incidence, associated factors, and outcomes of acute kidney injury following placement of antibiotic bone cement spacers in two-stage exchange for periprosthetic joint infection: a comprehensive study

Zhuo Li et al. Front Cell Infect Microbiol. .

Abstract

Background: Two-stage exchange with placement of antibiotic cement spacer (ACS) is the gold standard for the treatment of chronic periprosthetic joint infection (PJI), but it could cause a high prevalence of acute kidney injury (AKI). However, the results of the current evidence on this topic are too mixed to effectively guide clinical practice.

Methods: We retrospectively identified 340 chronic PJI patients who underwent the first-stage exchange with placement of ACS. The Kidney Disease Improving Global Outcomes guideline was used to define postoperative AKI. Multivariate logistic analysis was performed to determine the potential factors associated with AKI. Furthermore, a systematic review and meta-analysis on this topic were conducted to summarize the knowledge in the current literature further.

Results: In our cohort, the incidence of AKI following first-stage exchange was 12.1%. Older age (per 10 years, OR= 1.509) and preoperative hypoalbuminemia (OR= 3.593) were independent predictors for postoperative AKI. Eight AKI patients progressed to chronic kidney disease after 90 days. A meta-analysis including a total of 2525 PJI patients showed the incidence of AKI was 16.6%, and AKI requiring acute dialysis was 1.4%. Besides, host characteristics, poor baseline liver function, factors contributing to acute renal blood flow injury, and the use of nephrotoxic drugs may be associated with the development of AKI. However, only a few studies supported an association between antibiotic dose and AKI.

Conclusion: AKI occurs in approximately one out of every six PJI patients undergoing first-stage exchange. The pathogenesis of AKI is multifactorial, with hypoalbuminemia could be an overlooked associated factor. Although the need for acute dialysis is uncommon, the fact that some AKI patients will develop CKD still needs to be taken into consideration.

Keywords: acute kidney injury; antibiotic bone cement spacer; associated factors; incidence; outcome; periprosthetic joint infection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
This flowchart demonstrates how patients are identified for inclusion in the final cohort. PJI, periprosthetic joint infection; ICM, International Consensus Meeting; AKI, acute kidney injury.
Figure 2
Figure 2
Forest plots of the included studies assessing incidence of AKI (A) and AKI requiring dialysis (B).
See this image and copyright information in PMC

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