Acute Kidney Injury Following Primary Knee Replacement; Systematic Review

Objectives Knee Replacement (KR) is a highly-effective procedure for improving pain and function in patients. Acute Kidney Injury (AKI) is a potential complication that is associated with increased length of stay, morbidity and mortality. The aims of this systematic review were to establish the incidence of AKI following primary KR and to characterize risk factors for AKI and the incidence of Renal Replacement Therapy (RRT). Methods A systematic review of the literature was undertaken with a search of Medline, Embase, Scopus, Cochrane Library. The review included clinical trials or observational studies (cohort, case-control or cross-sectional studies) reporting the incidence of AKI following primary KR. Results 1,523 studies were identified in the initial search, with eight meeting the inclusion criteria. A total of 13,574 episodes of patients undergoing primary knee replacement were included. The mean age of patients was 68.91 years (SD 2.68). 11,346 (83.02%) of patients were female. The weighted pooled incidence of AKI in the included studies was 8.85 (95% CI 8.35% to 9.35%). Risk factors highlighted for AKI following primary KR frequently identified were Age >65, Diabetes Mellitus and pre-existing chronic kidney disease. There was limited data on the requirement for RRT. Conclusion AKI is one of the most common complications following KR. There is a need for research into interventions that may reduce the risk of AKI.