Prevalence of acute kidney injury in geriatric patients: Equal contribution of arthroplasty and osteosynthesis of the proximal femur
Besart Tara, Dominik Kylies, Matthias Priemel, Karl-Heinz Frosch, Tobias M. BallhauseBackground
Proximal femoral fractures (PFFs) are among the most common fragility fractures among the elderly, and their incidence is increasing due to demographic changes. Elderly patients are at risk for developing acute kidney injury (AKI), which is linked to adverse clinical outcomes, morbidity, and mortality. The aim of this study was to investigate the prevalence of AKI following surgery for PFFs among geriatric patients. Patients with femoral neck fractures (FNFs) received a prosthesis, while patients with intertrochanteric fractures (ITFs) were treated with osteosynthesis.
Methods
This retrospective single-center study was performed in a level-I trauma center and included 1554 patients with almost even distributions of FNF and ITF. Laboratory parameters, comorbidities, incidence of AKI, and need for dialysis were retrieved from electronic medical charts and statistically analyzed.
Results
During hospital stay, AKI occurred in 22.6% of patients with PFF. The most common AKI stage was stage I. AKI stage III (requiring acute dialysis) was uncommon with a rate of 1.48%. The occurrence of AKI was highly associated with longer stay in the intensive care unit (ICU) and led to a higher rate of inpatient death. On average, the serum creatinine (SCr) level at hospital admission was higher for patients with FNF than those with ITF. Patients with FNF had significantly more comorbidities. A low estimated glomerular filtration rate (eGFR) at admission was a risk factor for the development of AKI.
Conclusion
AKI is one of the most frequent and severe adverse events among geriatric patients with PFFs. Patients with low eGFR at admission had a higher risk for developing AKI than those with normal eGFR. No significant differences were observed in the prevalence of AKI between patients with FNF and ITF, although patients with FNF had more comorbidities and had longer hospital stays by one day on average.