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Risk for Acute Kidney Injury High With Protocol for Post-TKA Infection

AKI seen in 14 percent of patients treated with antibiotic-loaded bone cement spacer after resection of periprosthetic joint infection

WEDNESDAY, April 7, 2021 (HealthDay News) — Among patients with normal renal function at baseline who are treated with a high-dose antibiotic-loaded bone cement (ALBC) spacer and systemic antibiotic therapy after resection of a periprosthetic joint infection (PJI) following a primary total knee arthroplasty (TKA), 14 percent develop acute kidney injury (AKI), according to a study published online March 29 in The Journal of Bone & Joint Surgery.

Louis Dagneaux, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined the incidence, risk factors, and outcomes of AKI in a cohort of 424 patients who had been treated with 455 ALBC spacers after resection of a PJI following a primary TKA from 2000 to 2017. The spacers contained a mean of 8 g of vancomycin and 9 g of an aminoglycoside per construct; 86 spacers also had amphotericin B. All patients also received systemic antibiotics for a mean of six weeks.

The researchers identified 54 AKIs in 52 of the 359 patients (14 percent) without preexisting chronic kidney disease (CKD) versus 32 AKIs in 29 of the 65 patients (45 percent) with CKD (odds ratio, 5); none needed acute dialysis. The risk for AKI increased when the vancomycin concentration or aminoglycoside concentration was >3.6 g per batch of cement (odds ratios, 1.9 and 1.8, respectively). For patients without preexisting CKD, independent predictors for AKI included hypertension, perioperative hypovolemia, and acute atrial fibrillation. Eight patients who had sustained an AKI had progressed to CKD at last follow-up; four of these patients received dialysis.

“While higher antibiotic doses in ALBC spacers can lead to AKIs, these doses are also a crucial factor for infection eradication,” the authors write.

Several authors disclosed financial ties to the pharmaceutical, medical device, and publishing industries; one author holds a patent.

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