International Urology and Nephrology

, Volume 51, Issue 1, pp 147–153 | Cite as

The influence of chronic kidney disease on the duration of hospitalisation and transfusion rate after elective hip and knee arthroplasty

  • C. Kaiser
  • F. P. Tillmann
  • J. Löchter
  • S. Landgraeber
  • M. JägerEmail author
Nephrology - Original Paper



Elective hip or knee replacement is an optimal, standardised orthopaedic surgical procedure. The influence of chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) of 15–45 ml/min/1.73 m2 body surface area (BSA) (KDIGO stage G3a-G4), on the duration of hospitalisation, perioperative decrease in haemoglobin (Hb) levels, and transfusion rates after orthopaedic procedures has not been fully clarified. Our study, therefore, aimed to evaluate the impact of chronic kidney disease on the previously mentioned variables.


We conducted a retrospective multicentre analysis involving two orthopaedic centres. Patients who underwent elective total hip and knee replacement between 2010 and 2015 were included. We used descriptive methods and multivariate linear and binary regression analyses for our statistical evaluations.


We evaluated 3301 datasets (1120 men [33.9%], 2181 women [66.1%], 2043 [61.9%], and 1258 [38.1%]) elective total hip and knee replacements, respectively. The following variables were identified as risk factors for a prolonged hospital stay: patient age, admission Hb and potassium levels, perioperative Hb level decrease, year of surgery, blood transfusion, and a preoperative eGFR of 15–45 ml/min/m2 BSA. Patients with an eGFR of > 45 ml/min/m2 BSA were discharged within 11.7 ± 3.0 days, while patients with an eGFR of 15–45 ml/min/1.73 m2 BSA remained inpatient for 13.5 ± 5.0 days (p < 0.001). Identified risk factors for postoperative blood transfusions included age, initial Hb level, perioperative Hb decrease, prosthetic hip replacement, and the presence of allergic diathesis. Blood transfusions were performed in 7.5% of patients with an eGFR of > 45 ml/min/m2 BSA compared to 24.1% of patients with an eGFR of 15–45 ml/min/1.73 m2 BSA (p < 0.001). An eGFR level of 15–45 ml/min/m2 BSA was identified as a risk factor for a postoperative decrease in Hb levels.


Chronic kidney disease, defined as an eGFR level of 15–45 ml/min/1.73 m2 BSA, was a risk factor for a prolonged hospital stay after elective hip and knee arthroplasty. Further studies are necessary to better define the effect of reduced kidney function on relevant clinical and socioeconomic outcome parameters.


Joint replacement CKD Prolonged inpatient stay Blood transfusion 


Author Contributions

CK collected the data and helped in drafting the manuscript. FPT designed the study, performed the statistical analyses, and drafted the manuscript. IL performed the data acquisition and conceived the study. SL conceived the study and helped in drafting the manuscript. MJ designed and conceived the study, and helped in drafting the manuscript. All authors have read and approved the final manuscript. The authors CK and FPT contributed equally to the manuscript.

Compliance with Ethical Standards

Conflict of interest

All of the authors declare that they have no conflict of interest.

Ethical approval

All of the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


  1. 1.
    Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508–1519CrossRefGoogle Scholar
  2. 2.
    Fry DE, Pine M, Nedza SM, Locke DG, Reband AM, Pine G (2017) Risk-adjusted hospital outcomes in medicare total joint replacement surgical procedures. J Bone Joint Surg Am 99:10–18CrossRefGoogle Scholar
  3. 3.
  4. 4.
    Meding JB, Klay M, Healy A, Ritter MA, Keating EM, Berend ME (2007) The prescreening history and physical in elective total joint arthroplasty. J Arthroplast 22:21–23CrossRefGoogle Scholar
  5. 5.
    Scott JE, Mathias JL, Kneebone AC, Krishnan J (2017) Postoperative cognitive dysfunction and its relationship to cognitive reserve in elderly total joint replacement patients. J Clin Exp Neuropsychol 39:459–472CrossRefGoogle Scholar
  6. 6.
    Stevens PE, Lamb EJ, Levin A (2015) Integrating guidelines, CKD, multimorbidity, and older adults. Am J Kidney Dis 65:494–501CrossRefGoogle Scholar
  7. 7.
    Torres RV, Elias MF, Seliger S, Davey A, Robbins MA (2017) Risk for cognitive impairment across 22 measures of cognitive ability in early stage chronic kidney disease. Nephrol Dial Transplant 32:299–306CrossRefGoogle Scholar
  8. 8.
    Isakova T, Nickolas TL, Denburg M, Yarlagadda S, Weiner DE, Gutierrez OM et al (2017) KDOQI US commentary on the 2017 KDIGO clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of the chronic kidney disease-mineral and bone disorder (CKD-MBD). Am J Kidney Dis 70:737–751CrossRefGoogle Scholar
  9. 9.
    Babayev R, Nickolas TL (2015) Bone disorders in chronic kidney disease: an update in diagnosis and management. Semin Dial 28:645–653CrossRefGoogle Scholar
  10. 10.
    Molino D, De Lucia D, Gaspare De Santo N (2006) Coagulation disorders in uremia. Semin Nephrol 26:46–51CrossRefGoogle Scholar
  11. 11.
    Hsu CY, McCulloch CE, Curhan GC (2002) Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol 13:504–510CrossRefGoogle Scholar
  12. 12.
    Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AR 3rd, Feldman HI et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612CrossRefGoogle Scholar
  13. 13.
    Schwartz FH, Lange J (2017) Factors that affect outcome following total joint arthroplasty: a review of the recent literature. Curr Rev Musculoskelet Med 10:346–355CrossRefGoogle Scholar
  14. 14.
    Abbott KC, Bucci JR, Agodoa LY (2003) Total hip arthroplasty in chronic dialysis patients in the United States. J Nephrol 16:34–39Google Scholar
  15. 15.
    Bucci JR, Oglesby RJ, Agodoa LY, Abbott KC (2002) Hospitalizations for total hip arthroplasty after renal transplantation in the United States. Am J Transplant 2:999–1004CrossRefGoogle Scholar
  16. 16.
    Ackland GL, Moran N, Cone S, Grocott MP, Mythen MG (2011) Chronic kidney disease and postoperative morbidity after elective orthopedic surgery. Anesth Analg 112:1375–1381CrossRefGoogle Scholar
  17. 17.
    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:e613–e618CrossRefGoogle Scholar
  18. 18.
    Miric A, Inacio MC, Namba RS (2014) The effect of chronic kidney disease on total hip arthroplasty. J Arthroplast 29:1225–1230CrossRefGoogle Scholar
  19. 19.
    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 Arthroplast 30:51–54CrossRefGoogle Scholar
  20. 20.
    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 Arthroplast 31:465–472CrossRefGoogle Scholar
  21. 21.
    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 19:404–409CrossRefGoogle Scholar
  22. 22.
    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 Arthroplast 28:928–931CrossRefGoogle Scholar
  23. 23.
    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 Arthroplast 32:1630–1634CrossRefGoogle Scholar
  24. 24.
    Adogwa O, Elsamadicy AA, Sergesketter A, Oyeyemi D, Galan D, Vuong VD et al (2017) The impact of chronic kidney disease on post-operative outcomes in patients undergoing lumbar decompression and fusion. World Neurosurg 110:e266–e270CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • C. Kaiser
    • 1
  • F. P. Tillmann
    • 2
  • J. Löchter
    • 1
  • S. Landgraeber
    • 1
  • M. Jäger
    • 1
    Email author
  1. 1.Klinik für Orthopädie und UnfallchirurgieUniversitätsklinikum Essen, Universität Duisburg-EssenEssenGermany
  2. 2.Klinik für NephrologieHeinrich Heine Universität DüsseldorfDüsseldorfGermany

Personalised recommendations