Rate and Outcome of Acute Kidney Injury Following Hip Fracture Surgery in Diabetic Older Patients Treated with Renin–Angiotensin–Aldosterone Antagonists
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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.
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.
The study was approved by the institutional ethics committee in accordance with the Declaration of Helsinki.
Informed consent was not necessary because this study is retrospective.
- 5.Al-Ani AN, Samuelsson B, Tidermark J, Norling A, Ekstrom W, Cederholm T, et al. Early operation on patients with a hip fracture improved the ability to return to independent living: a prospective study of 850 patients. J Bone Jt Surg Am. 2008;90:1436–42. https://doi.org/10.2106/JBJS.G.00890.CrossRefGoogle Scholar
- 11.Ng YP, Balasubramanian GP, Heng YP, Kalaiselvan M, Teh YW, Cheong KM, et al. Renin angiotensin-aldosterone system (RAAS) blockers usage among type II diabetes mellitus patients: a retrospective study. Diabetes Metab Syndr. 2018;12:305–8. https://doi.org/10.1016/j.dsx.2017.12.005.CrossRefGoogle Scholar
- 16.Arora P, Rajagopalam S, Ranjan R, Kolli H, Singh M, Venuto R, et al. Preoperative use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers is associated with increased risk for acute kidney injury after cardiovascular surgery. Clin J Am Soc Nephrol. 2008;3:1266–73. https://doi.org/10.2215/CJN.05271107.CrossRefGoogle Scholar
- 17.Benedetto U, Sciarretta S, Roscitano A, Fiorani B, Refice S, Angeloni E, et al. Preoperative angiotensin-converting enzyme inhibitors and acute kidney injury after coronary artery bypass grafting. Ann Thorac Surg. 2008;86:1160–5. https://doi.org/10.1016/j.athoracsur.2008.06.018.CrossRefGoogle Scholar
- 19.Cheungpasitporn W, Thongprayoon C, Srivali N, O’Corragain OA, Edmonds PJ, Ungprasert P, et al. Preoperative renin-angiotensin system inhibitors use linked to reduced acute kidney injury: a systematic review and meta-analysis. Nephrol Dial Transplant. 2015;30:978–88. https://doi.org/10.1093/ndt/gfv023.CrossRefGoogle Scholar
- 25.Porter CJ, Moppett IK, Juurlink I, Nightingale J, Moran CG, Devonald MAJ. Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury. BMC Nephrol. 2017;18:20. https://doi.org/10.1186/s12882-017-0437-5.CrossRefGoogle Scholar
- 33.Zou Z, Yuan HB, Yang B, Xu F, Chen XY, Liu GJ, et al. Perioperative angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers for preventing mortality and morbidity in adults. Cochrane Database Syst Rev. 2016;1:CD009210. https://doi.org/10.1002/14651858.CD009210.pub2.Google Scholar