Rate and Outcome of Acute Kidney Injury Following Hip Fracture Surgery in Diabetic Older Patients Treated with Renin–Angiotensin–Aldosterone Antagonists

  • Tal Frenkel Rutenberg
  • Abdelazeez Bdeir
  • Benaya Rozen-Zvi
  • Yoav Rosenthal
  • Steven Velkes
  • Avraham Weiss
  • Yichayaou BelooseskyEmail author
Original Research Article



The use of renin–angiotensin–aldosterone system inhibitors has increased over the past few years. There are conflicting data as to their relationship with acute kidney injury following surgery.


The objective of the article was to evaluate the risk of acute kidney injury in diabetic older patients treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and their medical outcomes following fragility hip fracture surgery.


Consecutive diabetic patients presenting with fragility hip fractures to our primary trauma center between January 2012 and June 2016 were included. Demographic and clinical data, including co-morbidities, medication use, and laboratory results, were collected from the electronic medical records. The primary outcome was the incidence of acute kidney injury; the secondary outcome was 1-year mortality.


Two hundred and seventeen patients were included; 125 were receiving treatment with medications targeting the renin–angiotensin–aldosterone system. Demographic and clinical characteristics were similar between groups. No association was found between the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and the risk of acute kidney injury, which occurred in 25% of the cohort. Univariate analysis revealed that diuretic use, particularly furosemide, increased the risk of acute kidney injury during hospitalization (p = 0.003). However, in a multivariate analysis, only age and estimated glomerular filtration rates were associated with an increased risk of acute kidney injury. Patients with acute kidney injury were found to have increased mortality during the first post-operative year (p < 0.001).


Acute kidney injury is a frequent complication after hip fracture surgery in elderly diabetic patients and is associated with increased 1-year mortality; however, it was not found to be associated with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker pre-fracture treatment.



The authors thank Mrs. Phyllis Curchack for her editorial services.

Author Contributions

TFR contributed to the study design, collection of data, interpretation of the results, and writing of the manuscript. AB contributed to the study design, collection of data, interpretation of the results, and writing of the manuscript. BR-Z was involved in the interpretation of the results, verified the analytical methods, and contributed to the draft review. YR was involved in the interpretation of data and draft review. SV contributed to the study design, data collection, interpretation of data, and draft review. AW contributed to the study design, data collection, interpretation of data, and draft review. YB designed and directed the project and participated in the interpretation of data and writing of the manuscript.

Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this study.

Conflict of interest

Tal Frenkel Rutenberg, Abdelazeez Bdeir, Benaya Rozen-Zvi, Yoav Rosenthal, Steven Velkes, Avraham Weiss, and Yichayaou Beloosesky have no conflicts of interest that are directly relevant to the content of this study.

Ethical approval

The study was approved by the institutional ethics committee in accordance with the Declaration of Helsinki.

Informed consent

Informed consent was not necessary because this study is retrospective.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OrthopedicsRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
  2. 2.Department of NephrologyRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
  3. 3.Department of GeriatricsRabin Medical Center, Beilinson HospitalPetach TikvahIsrael
  4. 4.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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