KIDNEY INJURY AFTER ANTIBIOTIC SPACER IMPLANTATION FOR PROSTHETIC JOINT INFECTION

Background: The purpose of our study was to quantify the extent of kidney involvement during a two-stage approach for PJI. Methods: We conducted a multidisciplinary, retrospective evaluation of all infected total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients treated with a two-stage approach utilizing antibiotic impregnated cement spacers from August 2007-July 2011 at our institution. Data collected included demographics, medical comorbidities, surgical data as well as risk factors for kidney injury, such as nephrotoxic agents, hypotensive episodes and baseline kidney function. Results: Acute Kidney Injury (AKI) occurred in 7/34 (21%) of patients at a median of 147 days (52-596 days) and represents the time with the antibiotic cement spacer. Six additional patients showed a doubling of serum creatinine concentrations over baseline beyond the first 48 hours after surgery, giving a total incidence of 47% of post-operative kidney injury. Serum creatinine concentrations recovered to baseline in 44% (7/16) of patients. Two patients underwent dialysis for persistent elevated creatinine. Kidney injury was more likely among older patients (HR 1.4 for every 10 year increase, confidence interval [CI] 1.2-2.6; p<0.01), those with Chronic Kidney Disease represented by a lower eGFR at baseline (HR 0.7 for every 10 ml/min higher baseline eGFR, CI 0.5-0.9, p<0.01) and cardiovascular disease (CVD) (HR 4.7, CI 1.6-13.6, p<0.01). Conclusions: Kidney injury with elevation of serum creatinine over baseline occurs frequently following the first stage of a two-stage revision arthroplasty using antibiotic cement spacers, especially in patients with baseline comorbidities. Changes in kidney function after surgery are multi-factorial therefore further prospective studies are necessary to understand the causes and consequences