open access

Vol 47, No 4 (2015)
Original and clinical articles
Published online: 2015-05-26
Submitted: 2015-03-05
Accepted: 2015-05-19
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Renal injury during hip fracture surgery: an exploratory study

Robert G. Hahn
DOI: 10.5603/AIT.a2015.0029
·
Anaesthesiol Intensive Ther 2015;47(4):284-290.

open access

Vol 47, No 4 (2015)
Original and clinical articles
Published online: 2015-05-26
Submitted: 2015-03-05
Accepted: 2015-05-19

Abstract

BACKGROUND: The present observational study was undertaken to identify potential markers of poor outcome, such as renal failure and mortality, after hip fracture surgery.

METHODS: Forty-three patients, with a mean age of 78 years, were studied having undergone acute hip fracture surgery. Analysis included the urinary excretion of cortisol, albumin and sodium. The degree of fluid retention was evaluated based on the urinary excretion of metabolic end products. Fluid retention and the excretion of albumin and neutrophil gelatinase-associated lipocalin (NGAL) were measured repeatedly in a sub-group of 15 patients who also underwent haemodynamic monitoring. The perioperative change in serum creatinine and a 30-day mortality served as outcome measures.

RESULTS: Although serum creatinine increased by > 25% in 21% of the patients, only a high preoperative creatinine concentration correlated with a 30-day mortality. The subgroup analysis revealed that fluid retention was pronounced and remained essentially unchanged up to the first postoperative day. A rise in serum creatinine was always preceded by increased urinary excretion of NGAL that, in turn, was associated with preoperative fluid retention. The only perioperative event that correlated with a higher 30-day mortality was perioperative aggravation of albuminuria (67% vs 0%, P < 0.01), which became more common with advanced age and a low cardiac index.

CONCLUSIONS: Two different mechanisms seem to affect the kidneys during hip fracture surgery. The first elevates the serum creatinine concentration while the second increases the albuminuria. Only the second mechanism had a bearing on mortality.

Abstract

BACKGROUND: The present observational study was undertaken to identify potential markers of poor outcome, such as renal failure and mortality, after hip fracture surgery.

METHODS: Forty-three patients, with a mean age of 78 years, were studied having undergone acute hip fracture surgery. Analysis included the urinary excretion of cortisol, albumin and sodium. The degree of fluid retention was evaluated based on the urinary excretion of metabolic end products. Fluid retention and the excretion of albumin and neutrophil gelatinase-associated lipocalin (NGAL) were measured repeatedly in a sub-group of 15 patients who also underwent haemodynamic monitoring. The perioperative change in serum creatinine and a 30-day mortality served as outcome measures.

RESULTS: Although serum creatinine increased by > 25% in 21% of the patients, only a high preoperative creatinine concentration correlated with a 30-day mortality. The subgroup analysis revealed that fluid retention was pronounced and remained essentially unchanged up to the first postoperative day. A rise in serum creatinine was always preceded by increased urinary excretion of NGAL that, in turn, was associated with preoperative fluid retention. The only perioperative event that correlated with a higher 30-day mortality was perioperative aggravation of albuminuria (67% vs 0%, P < 0.01), which became more common with advanced age and a low cardiac index.

CONCLUSIONS: Two different mechanisms seem to affect the kidneys during hip fracture surgery. The first elevates the serum creatinine concentration while the second increases the albuminuria. Only the second mechanism had a bearing on mortality.

Get Citation

Keywords

acute kidney injury; albuminuria, mortality; creatinine; hip fracture, surgery

About this article
Title

Renal injury during hip fracture surgery: an exploratory study

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47, No 4 (2015)

Pages

284-290

Published online

2015-05-26

DOI

10.5603/AIT.a2015.0029

Bibliographic record

Anaesthesiol Intensive Ther 2015;47(4):284-290.

Keywords

acute kidney injury
albuminuria
mortality
creatinine
hip fracture
surgery

Authors

Robert G. Hahn

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