University of Oulu

Nikkinen, O, Jämsä, E, Aaltonen, T, Alahuhta, S, Ohtonen, P, Vakkala, M. Perioperative acute kidney injury and urine output in lower limb arthroplasties. Acta Anaesthesiol Scand. 2021; 65: 1054– 1064.

Perioperative acute kidney injury and urine output in lower limb arthroplasties

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Author: Nikkinen, Okke1; Jämsä, Elias2; Aaltonen, Ton2;
Organizations: 1Medical Research Center Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
2Faculty of Medicine, University of Oulu, Oulu, Finland
3Division of Operative Care, Oulu University Hospital, Oulu, Finland
4Department of Anaesthesiology, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-09-28


Background: This study aimed to evaluate the occurrence and perioperative risk factors of acute kidney injury (AKI) in primary elective hip and knee and emergency hip arthroplasty patients. We also aimed to assess the effect of urine output (UOP) as a diagnostic criterion in addition to serum creatinine (sCr) levels. We hypothesized that emergency arthroplasties are prone to AKI and that UOP is an underrated marker of AKI.

Methods: This retrospective, register-based study assessed 731 patients who underwent primary elective knee or hip arthroplasty and 170 patients who underwent emergency hip arthroplasty at Oulu University Hospital, Finland, between January 2016 and February 2017.

Results: Of the elective patients, 18 (2.5%) developed AKI. The 1-year mortality rate was 1.5% in elective patients without AKI and 11.1% in those with AKI (P = .038). Of the emergency patients, 24 (14.1%) developed AKI. The mortality rate was 16.4% and 37.5% in emergency patients without and with AKI, respectively (P = .024). In an AKI subgroup analysis of the combined elective and emergency patients, the mortality rate was 31.3% (n = 5) in the sCr group (n = 16), 23.5% (n = 4) in the UOP group (n = 17), and 22.2% (n = 2) in AKI patients who met both the sCr and UOP criteria (n = 9).

Conclusion: Emergency hip arthroplasty is associated with an increased risk of AKI. Since AKI increases mortality in both elective and emergency arthroplasty, perioperative oliguria should also be considered as a diagnostic criterion for AKI. Focusing solely on sCr may overlook many cases of AKI.

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Series: Acta anaesthesiologica Scandinavica
ISSN: 0001-5172
ISSN-E: 1399-6576
ISSN-L: 0001-5172
Volume: 65
Issue: 8
Pages: 1054 - 1064
DOI: 10.1111/aas.13834
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: The authors declare no conflicts of interest. However, EJ and TA received a grant for data collection from the Finnish State Research Fund appointed to the Department of Anaesthesiology, Oulu University Hospital. Further, ON received a grant from the Finnish Kidney Foundation.
Copyright information: © 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.