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Impact of chronic kidney disease on outcomes after total joint arthroplasty: a meta-analysis and systematic review

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Abstract

Objective

Comorbidities in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) may compromise outcomes with increased hospital stays, re-admission, and mortality rates. We aimed to determine whether chronic kidney disease (CKD) affects post-operative outcomes of patients undergoing total joint arthroplasty (TJA).

Methods

To identify studies for this review and meta-analysis, two independent reviewers searched PubMed, Cochrane, EMBASE, and Google Scholar until April 1, 2019, and identified additional studies by manual search of reference lists. Prospective or retrospective studies with quantitative outcomes for patients undergoing TJA were selected. Outcomes were compared between patients with underlying CKD stage ≥ 3 or eGFR < 60 mL/min/1.73 m2 versus mild/non-CKD as controls. Main endpoints were mortality, re-operation, and re-admission rates.

Results

Among 59 studies reviewed, 19 meeting the eligibility criteria were included, providing data of 2,141,393 patients. After THA or TKA, CKD was associated with higher mortality risk than non-CKD (pooled OR 2.20, 95%CI = 1.90 to 2.54; P < 0.001); no significant differences were seen in re-operation between CKD and non-CKD patients (pooled OR 1.26, 95%CI = 0.84 to 1.88; P = 0.266); and CKD patients had higher any-cause re-admission rates (pooled OR = 1.57, 95%CI = 1.27 to 1.94, P < 0.001).

Conclusion

Underlying CKD predicts adverse outcomes after elective TJA with increased risk of mortality, re-admission, surgical site infection, and perioperative transfusion. Findings of this review and meta-analysis highlight CKD as a critical contributor to complications after TJA and may be helpful to surgeons when advising patients about associated risks of TJA.

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References

  1. Podmore B, Hutchings A, van der Meulen J, Aggarwal A, Konan S (2018) Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis. BMJ Open 8(7):e021784. https://doi.org/10.1136/bmjopen-2018-021784

    Article  PubMed  PubMed Central  Google Scholar 

  2. Haynes J, Nam D, Barrack RL (2017) Obesity in total hip arthroplasty: does it make a difference? Bone Joint J 99-b(1 Supple A):31–36. https://doi.org/10.1302/0301-620x.99b1.Bjj-2016-0346.R1

    Article  CAS  PubMed  Google Scholar 

  3. Curtis GL, Newman JM, George J, Klika AK, Barsoum WK, Higuera CA (2018) Perioperative outcomes and complications in patients with heart failure following total knee arthroplasty. J Arthroplasty 33(1):36–40. https://doi.org/10.1016/j.arth.2017.07.043

    Article  PubMed  Google Scholar 

  4. Gold HT, Slover JD, Joo L, Bosco J, Iorio R, Oh C (2016) Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplasty 31(11):2385–2388. https://doi.org/10.1016/j.arth.2016.04.010

    Article  PubMed  Google Scholar 

  5. Rasouli MR, Menendez ME, Sayadipour A, Purtill JJ, Parvizi J (2016) Direct cost and complications associated with total joint arthroplasty in patients with preoperative anxiety and depression. J Arthroplasty 31(2):533–536. https://doi.org/10.1016/j.arth.2015.09.015

    Article  PubMed  Google Scholar 

  6. Klement MR, Nickel BT, Penrose CT, Bala A, Green CL, Wellman SS, Bolognesi MP, Seyler TM (2016) Psychiatric disorders increase complication rate after primary total knee arthroplasty. Knee 23(5):883–886. https://doi.org/10.1016/j.knee.2016.05.007

    Article  PubMed  Google Scholar 

  7. Bolognesi MP, Marchant MH Jr, Viens NA, Cook C, Pietrobon R, Vail TP (2008) The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States. J Arthroplasty 23(6 Suppl 1):92–98. https://doi.org/10.1016/j.arth.2008.05.012

    Article  PubMed  Google Scholar 

  8. Yang Z, Liu H, Xie X, Tan Z, Qin T, Kang P (2014) The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis. Bone Joint J 96-b(12):1637–1643. https://doi.org/10.1302/0301-620x.96b12.34378

    Article  CAS  PubMed  Google Scholar 

  9. Maradit Kremers H, Lewallen LW, Mabry TM, Berry DJ, Berbari EF, Osmon DR (2015) Diabetes mellitus, hyperglycemia, hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty. J Arthroplasty 30(3):439–443. https://doi.org/10.1016/j.arth.2014.10.009

    Article  PubMed  Google Scholar 

  10. Issa K, Boylan MR, Naziri Q, Perfetti DC, Maheshwari AV, Mont MA (2015) The impact of hepatitis c on short-term outcomes of total joint arthroplasty. J Bone Joint Surg Am 97(23):1952–1957. https://doi.org/10.2106/JBJS.O.00183

    Article  PubMed  Google Scholar 

  11. Jiang SL, Schairer WW, Bozic KJ (2014) Increased rates of periprosthetic joint infection in patients with cirrhosis undergoing total joint arthroplasty. Clin Orthop Relat Res 472(8):2483–2491. https://doi.org/10.1007/s11999-014-3593-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Deleuran T, Vilstrup H, Overgaard S, Jepsen P (2015) Cirrhosis patients have increased risk of complications after hip or knee arthroplasty. Acta Orthop 86(1):108–113. https://doi.org/10.3109/17453674.2014.961397

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bellamy JL, Runner RP, Vu CCL, Schenker ML, Bradbury TL, Roberson JR (2017) Modified frailty index is an effective risk assessment tool in primary total hip arthroplasty. J Arthroplasty 32(10):2963–2968. https://doi.org/10.1016/j.arth.2017.04.056

    Article  PubMed  Google Scholar 

  14. Cobos R, Latorre A, Aizpuru F, Guenaga JI, Sarasqueta C, Escobar A, Garcia L, Herrera-Espineira C (2010) Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord 11:249. https://doi.org/10.1186/1471-2474-11-249

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJL, Mann JF, Matsushita K, Wen CP (2013) Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 382(9889):339–352. https://doi.org/10.1016/s0140-6736(13)60595-4

    Article  PubMed  Google Scholar 

  16. Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX (2006) Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 17(7):2034–2047. https://doi.org/10.1681/ASN.2005101085

    Article  PubMed  Google Scholar 

  17. Ryan TP, Fisher SG, Elder JL, Winters PC, Beckett W, Tacci J, Sloand JA (2009) Increased cardiovascular risk associated with reduced kidney function. Am J Nephrol 29(6):620–625. https://doi.org/10.1159/000194455

    Article  PubMed  PubMed Central  Google Scholar 

  18. Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, van Veldhuisen DJ, Hillege HL (2007) Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail 13(8):599–608. https://doi.org/10.1016/j.cardfail.2007.04.008

    Article  PubMed  Google Scholar 

  19. Mathew A, Devereaux PJ, O’Hare A, Tonelli M, Thiessen-Philbrook H, Nevis IF, Iansavichus AV, Garg AX (2008) Chronic kidney disease and postoperative mortality: a systematic review and meta-analysis. Kidney Int 73(9):1069–1081. https://doi.org/10.1038/ki.2008.29

    Article  CAS  PubMed  Google Scholar 

  20. Ackland GL, Moran N, Cone S, Grocott MP, Mythen MG (2011) Chronic kidney disease and postoperative morbidity after elective orthopedic surgery. Anesth Analg 112(6):1375–1381. https://doi.org/10.1213/ANE.0b013e3181ee8456

    Article  PubMed  Google Scholar 

  21. Warth LC, Pugely AJ, Martin CT, Gao Y, Callaghan JJ (2015) Total joint arthroplasty in patients with chronic renal disease: is it worth the risk? J Arthroplasty 30(9 Suppl):51–54. https://doi.org/10.1016/j.arth.2014.12.037

    Article  PubMed  Google Scholar 

  22. Sloan M, Premkumar A, Sheth NP (2018) Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 100(17):1455–1460. https://doi.org/10.2106/JBJS.17.01617

    Article  PubMed  Google Scholar 

  23. Hayden JA, van der Windt DA, Cartwright JL, Cote P, Bombardier C (2013) Assessing bias in studies of prognostic factors. Ann Intern Med 158(4):280–286. https://doi.org/10.7326/0003-4819-158-4-201302190-00009

    Article  PubMed  Google Scholar 

  24. Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36(5):309–332. https://doi.org/10.1016/j.ajic.2008.03.002

    Article  PubMed  Google Scholar 

  25. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, Carpenter J, Rucker G, Harbord RM, Schmid CH, Tetzlaff J, Deeks JJ, Peters J, Macaskill P, Schwarzer G, Duval S, Altman DG, Moher D, Higgins JP (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 343:d4002. https://doi.org/10.1136/bmj.d4002

    Article  Google Scholar 

  26. Cavanaugh PK, Chen AF, Rasouli MR, Post ZD, Orozco FR, Ong AC (2016) Complications and mortality in chronic renal failure patients undergoing total joint arthroplasty: a comparison between dialysis and renal transplant patients. J Arthroplasty 31(2):465–472. https://doi.org/10.1016/j.arth.2015.09.003

    Article  PubMed  Google Scholar 

  27. Jamsa P, Jamsen E, Huhtala H, Eskelinen A, Oksala N (2018) Moderate to severe renal insufficiency is associated with high mortality after hip and knee replacement. Clin Orthop Relat Res 476(6):1284–1292. https://doi.org/10.1007/s11999.0000000000000256

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rhee C, Lethbridge L, Richardson G, Dunbar M (2018) Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty. Can J Surg 61(3):165–176

    Article  Google Scholar 

  29. Kuo LT, Lin SJ, Chen CL, Yu PA, Hsu WH, Chen TH (2017) Chronic kidney disease is associated with a risk of higher mortality following total knee arthroplasty in diabetic patients: a nationwide population-based study. Oncotarget 8(59):100288–100295. https://doi.org/10.18632/oncotarget.22215

    Article  PubMed  PubMed Central  Google Scholar 

  30. Erkocak OF, Yoo JY, Restrepo C, Maltenfort MG, Parvizi J (2016) Incidence of infection and inhospital mortality in patients with chronic renal failure after total joint arthroplasty. J Arthroplasty 31(11):2437–2441. https://doi.org/10.1016/j.arth.2016.04.031

    Article  PubMed  Google Scholar 

  31. Deegan BF, Richard RD, Bowen TR, Perkins RM, Graham JH, Foltzer MA (2014) Impact of chronic kidney disease stage on lower-extremity arthroplasty. Orthopedics 37(7):e613–e618. https://doi.org/10.3928/01477447-20140626-51

    Article  PubMed  Google Scholar 

  32. Graves A, Yates P, Hofmann AO, Farmer S, Ferrari P (2014) Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty. Nephrology (Carlton) 19(7):404–409. https://doi.org/10.1111/nep.12239

    Article  CAS  Google Scholar 

  33. Miric A, Inacio MC, Namba RS (2014) The effect of chronic kidney disease on total hip arthroplasty. J Arthroplasty 29(6):1225–1230. https://doi.org/10.1016/j.arth.2013.12.031

    Article  PubMed  Google Scholar 

  34. Miric A, Inacio MC, Namba RS (2014) Can total knee arthroplasty be safely performed in patients with chronic renal disease? Acta Orthop 85(1):71–78. https://doi.org/10.3109/17453674.2013.878829

    Article  PubMed  PubMed Central  Google Scholar 

  35. Jamsen E, Puolakka T, Eskelinen A, Jantti P, Kalliovalkama J, Nieminen J, Valvanne J (2013) Predictors of mortality following primary hip and knee replacement in the aged. A single-center analysis of 1,998 primary hip and knee replacements for primary osteoarthritis. Acta Orthop 84(1):44–53. https://doi.org/10.3109/17453674.2012.752691

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bozic KJ, Lau E, Kurtz S, Ong K, Rubash H, Vail TP, Berry DJ (2012) Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am 94(9):794–800. https://doi.org/10.2106/JBJS.K.00072

    Article  PubMed  Google Scholar 

  37. Kuo FC, Lin PC, Lu YD, Lee MS, Wang JW (2017) Chronic kidney disease is an independent risk factor for transfusion, cardiovascular complication, and thirty-day readmission in minimally invasive total knee arthroplasty. J Arthroplasty 32(5):1630–1634. https://doi.org/10.1016/j.arth.2016.12.006

    Article  PubMed  Google Scholar 

  38. Urish KL, Qin Y, Li BY, Borza T, Sessine M, Kirk P, Hollenbeck BK, Helm JE, Lavieri MS, Skolarus TA, Jacobs BL (2018) Predictors and cost of readmission in total knee arthroplasty. J Arthroplasty 33(9):2759–2763. https://doi.org/10.1016/j.arth.2018.04.008

    Article  PubMed  PubMed Central  Google Scholar 

  39. Siracuse BL, Chamberlain RS (2016) A preoperative scale for determining surgical readmission risk after total hip replacement. JAMA Surg 151(8):701–709. https://doi.org/10.1001/jamasurg.2016.0020

    Article  PubMed  Google Scholar 

  40. Siracuse BL, Ippolito JA, Gibson PD, Ohman-Strickland PA, Beebe KS (2017) A preoperative scale for determining surgical readmission risk after total knee arthroplasty. J Bone Joint Surg Am 99(21):e112. https://doi.org/10.2106/JBJS.16.01043

    Article  PubMed  Google Scholar 

  41. Li Q, Dai B, Yao Y, Song K, Chen D, Jiang Q (2017) Chronic kidney dysfunction can increase the risk of deep vein thrombosis after total hip and knee arthroplasty. Biomed Res Int 2017:8260487. https://doi.org/10.1155/2017/8260487

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Kaiser C, Tillmann FP, Lochter J, Landgraeber S, Jager M (2019) The influence of chronic kidney disease on the duration of hospitalisation and transfusion rate after elective hip and knee arthroplasty. Int Urol Nephrol 51(1):147–153. https://doi.org/10.1007/s11255-018-2008-5

    Article  CAS  PubMed  Google Scholar 

  43. Augustin ID, Yeoh TY, Sprung J, Berry DJ, Schroeder DR, Weingarten TN (2013) Association between chronic kidney disease and blood transfusions for knee and hip arthroplasty surgery. J Arthroplasty 28(6):928–931. https://doi.org/10.1016/j.arth.2013.02.004

    Article  PubMed  Google Scholar 

  44. Cavanaugh PK, Chen AF, Rasouli MR, Post ZD, Orozco FR, Ong AC (2015) Total joint arthroplasty in transplant recipients: in-hospital adverse outcomes. J Arthroplasty 30(5):840–845. https://doi.org/10.1016/j.arth.2014.11.037

    Article  PubMed  Google Scholar 

  45. Patterson JT, Tillinghast K, Ward D (2018) Dialysis dependence predicts complications, intensive care unit care, length of stay, and skilled nursing needs in elective primary total knee and hip arthroplasty. J Arthroplasty 33(7):2263–2267. https://doi.org/10.1016/j.arth.2018.02.035

    Article  PubMed  Google Scholar 

  46. Ponnusamy KE, Jain A, Thakkar SC, Sterling RS, Skolasky RL, Khanuja HS (2015) Inpatient mortality and morbidity for dialysis-dependent patients undergoing primary total hip or knee arthroplasty. J Bone Joint Surg Am 97(16):1326–1332. https://doi.org/10.2106/JBJS.N.01301

    Article  PubMed  Google Scholar 

  47. Ottesen TD, Zogg CK, Haynes MS, Malpani R, Bellamkonda KS, Grauer JN (2018) Dialysis patients undergoing total knee arthroplasty have significantly increased odds of perioperative adverse events independent of demographic and comorbidity factors. J Arthroplasty 33(9):2827–2834. https://doi.org/10.1016/j.arth.2018.04.012

    Article  PubMed  Google Scholar 

  48. Gwam CU, Mistry JB, Mohamed NS, Thomas M, Bigart KC, Mont MA, Delanois RE (2017) Current epidemiology of revision total hip arthroplasty in the United States: National Inpatient Sample 2009 to 2013. J Arthroplasty 32(7):2088–2092. https://doi.org/10.1016/j.arth.2017.02.046

    Article  PubMed  Google Scholar 

  49. Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA (2017) Current epidemiology of revision total knee arthroplasty in the United States. J Arthroplasty 32(9):2663–2668. https://doi.org/10.1016/j.arth.2017.03.066

    Article  PubMed  Google Scholar 

  50. Jasper LL, Jones CA, Mollins J, Pohar SL, Beaupre LA (2016) Risk factors for revision of total knee arthroplasty: a scoping review. BMC Musculoskelet Disord 17:182. https://doi.org/10.1186/s12891-016-1025-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Prokopetz JJ, Losina E, Bliss RL, Wright J, Baron JA, Katz JN (2012) Risk factors for revision of primary total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 13:251. https://doi.org/10.1186/1471-2474-13-251

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ramkumar PN, Chu CT, Harris JD, Athiviraham A, Harrington MA, White DL, Berger DH, Naik AD, Li LT (2015) Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis. Am J Orthop (Belle Mead NJ) 44(9):397–405

    Google Scholar 

  53. Dua A, Desai SS, Lee CJ, Heller JA (2017) National trends in deep vein thrombosis following total knee and total hip replacement in the United States. Ann Vasc Surg 38:310–314. https://doi.org/10.1016/j.avsg.2016.05.110

    Article  PubMed  Google Scholar 

  54. Zhang ZH, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX (2015) Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC Musculoskelet Disord 16:24. https://doi.org/10.1186/s12891-015-0470-0

    Article  PubMed  PubMed Central  Google Scholar 

  55. Ocak G, Lijfering WM, Verduijn M, Dekker FW, Rosendaal FR, Cannegieter SC, Vossen CY (2013) Risk of venous thrombosis in patients with chronic kidney disease: identification of high-risk groups. J Thromb Haemost 11(4):627–633. https://doi.org/10.1111/jth.12141

    Article  CAS  PubMed  Google Scholar 

  56. Slover J, Lavery JA, Schwarzkopf R, Iorio R, Bosco J, Gold HT (2017) Incidence and risk factors for blood transfusion in total joint arthroplasty: analysis of a statewide database. J Arthroplasty 32(9):2684–2687 e2681. https://doi.org/10.1016/j.arth.2017.04.048

    Article  PubMed  Google Scholar 

  57. (2004) National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32(8):470–485. https://doi.org/10.1016/s0196655304005425

  58. Mistry JB, Naqvi A, Chughtai M, Gwam C, Thomas M, Higuera CA, Mont MA, Delanois RE (2017) Decreasing the incidence of surgical-site infections after total joint arthroplasty. Am J Orthop (Belle Mead NJ) 46(6):E374–e387

    Google Scholar 

  59. Elsiwy Y, Jovanovic I, Doma K, Hazratwala K, Letson H (2019) Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review. J Orthop Surg Res 14(1):15. https://doi.org/10.1186/s13018-018-1058-9

    Article  PubMed  PubMed Central  Google Scholar 

  60. Pedersen AB, Mehnert F, Sorensen HT, Emmeluth C, Overgaard S, Johnsen SP (2014) The risk of venous thromboembolism, myocardial infarction, stroke, major bleeding and death in patients undergoing total hip and knee replacement: a 15-year retrospective cohort study of routine clinical practice. Bone Joint J 96-b(4):479–485. https://doi.org/10.1302/0301-620x.96b4.33209

    Article  CAS  PubMed  Google Scholar 

  61. Rasouli MR, Tabatabaee RM, Maltenfort MG, Chen AF (2016) Acute stroke after total joint arthroplasty: a population-based trend analysis. J Clin Anesth 34:15–20. https://doi.org/10.1016/j.jclinane.2016.03.034

    Article  PubMed  Google Scholar 

  62. Basilico FC, Sweeney G, Losina E, Gaydos J, Skoniecki D, Wright EA, Katz JN (2008) Risk factors for cardiovascular complications following total joint replacement surgery. Arthritis Rheum 58(7):1915–1920. https://doi.org/10.1002/art.23607

    Article  PubMed  PubMed Central  Google Scholar 

  63. Belmont PJ Jr, Goodman GP, Kusnezov NA, Magee C, Bader JO, Waterman BR, Schoenfeld AJ (2014) Postoperative myocardial infarction and cardiac arrest following primary total knee and hip arthroplasty: rates, risk factors, and time of occurrence. J Bone Joint Surg Am 96(24):2025–2031. https://doi.org/10.2106/JBJS.N.00153

    Article  PubMed  Google Scholar 

  64. Lu N, Misra D, Neogi T, Choi HK, Zhang Y (2015) Total joint arthroplasty and the risk of myocardial infarction: a general population, propensity score-matched cohort study. Arthritis Rheumatol 67(10):2771–2779. https://doi.org/10.1002/art.39246

    Article  PubMed  PubMed Central  Google Scholar 

  65. Menendez ME, Memtsoudis SG, Opperer M, Boettner F, Gonzalez Della Valle A (2015) A nationwide analysis of risk factors for in-hospital myocardial infarction after total joint arthroplasty. Int Orthop 39(4):777–786. https://doi.org/10.1007/s00264-014-2502-z

    Article  PubMed  Google Scholar 

  66. Petersen PB, Kehlet H, Jorgensen CC, Lundbeck Foundation Center for Fast-track H, Knee Replacement Collaborative G (2018) Myocardial infarction following fast-track total hip and knee arthroplasty-incidence, time course, and risk factors: a prospective cohort study of 24,862 procedures. Acta Orthop 89(6):603–609. https://doi.org/10.1080/17453674.2018.1517487

    Article  PubMed  PubMed Central  Google Scholar 

  67. van Tulder M, Furlan A, Bombardier C, Bouter L (2003) Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976) 28(12):1290–1299. https://doi.org/10.1097/01.Brs.0000065484.95996.Af

    Article  Google Scholar 

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Funding

This study was financially supported by the National Key Research and Development Program of China (No. 2017YFC1700402); Program of National Natural Science Foundation of China (No. 81603638); the Fundamental Research Funds for the Central Universities (No. 2018-JYB-XJQ010); and Young Scientist Development Program, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine (No. DZMYS-201702).

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  1. Jiang Chen and Fan Zhang contributed equally to this work.

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  1. Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5, Hutong, Haiyuncang, Dongcheng District, Beijing City, 100700, China

    Jiang Chen, Fan Zhang, Chu-Yin Liu, Qiao-Mei Yuan, Xue-Shi Di, Shui-Wen Long, Hong-Cai Shang & Yu-Song Jia

  2. Hunan University of Chinese Medicine, Changsha City, Hunan Province, China

    Jiang Chen & Hong-Cai Shang

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Chen, J., Zhang, F., Liu, CY. et al. Impact of chronic kidney disease on outcomes after total joint arthroplasty: a meta-analysis and systematic review. International Orthopaedics (SICOT) 44, 215–229 (2020). https://doi.org/10.1007/s00264-019-04437-4

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