The prevalence and risk factors of acute kidney injury in patients undergoing hip fracture surgery: a meta-analysis

Figures & data

Table 1. Baseline characteristics of included studies in the meta-analysis

Study/year	Study period	Country	Operation	Age(years)	N with AKI	N total	AKI Definition	Study design
Craig 2012[16]	September and November 2010	United Kingdom	Surgery for fractured neck of femur	Study group (80.3 years); control group (83.6 years)	13	100	An increase in serum creatinine by over 50% of baseline	Historical cohort study
Ulucay 2012[17]	2007–2010	Turkey	Surgery for femoral neck fracture	>65 years	25	163	AKIN classification	Prospective cohort study
Marty 2016[3]	May-October 2012	France	Hip fracture surgery	83(75–92) years	29	48	AKIN classification	Prospective cohort study
Pedersen 2016[19]	2005–2011	Denmark	Hip fracture surgery	>65 years	1717	13,529	KDIGO classification	Regional cohort study
Hong 2017[18]	2010–2012	Korea	Hip fracture surgery	>65 years	95	450	AKIN classification	Retrospective cohort study
Shin 2018[6]	2011–2016	Korea	Surgery for intertrochanteric fracture of the proximal femur	>60 years	57	481	KDIGO classification	Retrospective cohort study
Frenkelrutenberg 2019[20]	2012–2016	Israel	Surgery for fragility hip fractureS	>65 years	55	217	AKIN classification	Retrospective cohort study
Jang 2019[21]	2011–2015	Korea	Femoral neck fracture surgery	77.6(65–97) years	44	248	KDIGO classification	Retrospective cohort study
Rantalaiho 2019[22]	2017–2018	Finland	Hip fracture surgery	>65 years	40	475	KDIGO classification	Retrospective cohort study
Kang 2020[8]	2011–2016	Korea	Hip fracture surgery	70.1 years	25	550	AKIN classification	Case–control study
Küpeli 2020[23]	January (1–7), 2018	Turkey	Hip fracture surgery	>65 years	28	160	KDIGO classification	Retrospective descriptive study

AKI, Acute Kidney Injury; KDIGO, Kidney Disease Improving Global Outcome; AKIN, Acute Kidney Injury Network

Table 2. NOS score of included studies in the meta-analysis

Study	Selection	Comparability	Exposure	Total Score
Craig 2012[16]	2	2	3	7
Ulucay 2012[17]	3	2	3	8
Marty 2016[3]	3	2	3	8
Pedersen 2016[19]	3	2	3	8
Hong 2017[18]	3	2	2	7
Shin 2018[6]	3	2	3	8
Frenkelrutenberg 2019[20]	2	2	3	7
Jang 2019[21]	3	2	3	8
Rantalaiho 2019[22]	2	2	3	7
Kang 2020[8]	2	2	3	7
Küpeli 2020[23]	2	2	2	6

NOS, Newcastle–Ottawa Scale

Figure 1. Flow diagram of the selection of studies for this meta-analysis

Table 3. Subgroup analysis for the prevalence of AKI in patients undergoing hip fracture surgery

Outcomes	Number of trials	Pooled prevalence with 95%CI	I^2 (%)
Primary analysis	11	0.17(0.14–0.21)	95
Region
Asia	7	0.22(0.15–0.29)	93.9
Europe	4	0.12(0.07–0.18)	97
Sample size
>500	2	0.40(0.02–0.79)	96.5
≤500	9	0.15(0.11–0.18)	94
Study design
Cohort study	9	0.14(0.11–0.18)	94.1
Others	2	0.43(0.11–0.76)	94.3
AKI Definition
Self-definition	1	0.12(0.06–0.18)
KDIGO	5	0.17(0.09–0.25)	96.7
AKIN	5	0.20(0.15–0.25)	92.4
NOS score
>7	5	0.17(0.12–0.21)	92.2
≤7	6	0.20(0.12–0.29)	95.9

AKI, Acute Kidney Injury; CI, Confidence interval; KDIGO, Kidney Disease Improving Global Outcome; AKIN, Acute Kidney Injury Network

Figure 2. Forest plot for prevalence of AKI in patients undergoing hip fracture surgery using random-effects mode

Figure 3. Sensitivity analysis for prevalence of AKI in patients undergoing hip fracture surgery in the meta-analysis

Figure 4. Funnel plot for prevalence of AKI in patients undergoing hip fracture surgery. (Egger’s test, p = 0.258 and Begg’s test, p = 0.087)

Table 4. Risk factors associated with AKI on multivariate model in patients undergoing hip fracture surgery

Study	Risk factors on multivariate model
Ulucay 2012[17]	Age, years: (OR 1.049, 95%CI 0.984–1.118); Gender (female):(OR 2.643, 95%CI 0.909–7.686); Potassium: (OR 1.688, 95%CI 0.693–4.110); eGFR:(OR 0.945, 95%CI 0.921–0.963)
Marty 2016[3]	Preop RI:(OR 0.03, 95%CI 0.01–75,228);Postop RI:(OR 1.6*10^12, 95%CI 3779–679*10^18); GFR Preop:(OR 9.7, 95%CI 0.88–107); Age, years: (OR 0.92, 95%CI 0.84–1.01)
Pedersen 2016[19]	Obese patients for AKI 1 stage(HR 1.4, 95%CI 1.1–1.8), AKI 2 stage(HR 1.9, 95%CI 1.3–3.0), AKI 3 stage(HR 2.8, 95%CI 1.5–4.9)
Shin 2018[6]	Age (years):(OR 1.022, 95%CI 0.983–1.064); Chronic kidney disease:(OR 3.879, 95%CI 1.885–7.981);ACE inhibitors(OR 1.751, 95%CI 0.928–3.302);NSAIDs(OR 0.718, 95%CI 0.339–1.291); Koval score(OR 1.067, 95%CI 0.916–1.244);Postoperative serum albumin(OR 1.972, 95%CI 1.029–3.779); Postoperative drained blood volume(OR 1.003, 95%CI 0.999–1.007)
Jang 2019[21]	Type of operation(OR 0.33, 95%CI 0.09–0.94); Diabetes mellitus:(OR 2.36, 95%CI 0.80–7.01);Previous renal disease(OR 2.57, 95%CI 0.60–3.24);ACE inhibitor(OR 1.43, 95%CI 0.50–1.17); Hemoglobin(OR 1.43, 95%CI 0.50–1.17);BUN(OR 1.03, 95%CI 0.99–1.08);eGFR(OR 1.02, 95%CI 0.99–1.04); Intraoperative hypotension(OR 5.14, 95%CI 1.54–20.35)
Rantalaiho 2019[22]	Dementia(RR 2.37, 95%CI 1.00–4.98); Preoperative sCr:(RR 1.01, 95%CI 1.01–1.02)
Kang 2020[8]	Hospitalization(OR 1.24, 95%CI 0.96–1.57);EBL(OR 1.54, 95%CI 1.32–2.44);Postoperative serum albumin(OR 1.77, 95%CI 1.52–2.74)

AKI, Acute Kidney Injury; OR, odds ratio; CI, Confidence interval; eGFR, estimated glomerular filtration rate; GFR: glomerular filtration rate; preop RI: preoperative doppler renal resistive index; postop RI: postoperative doppler renal resistive index; HR, hazard ratio; ACE inhibitors = angiotensin-converting enzyme inhibitors; NSAIDS = Non-steroidal anti-inflammatory drugs; BUN, blood urea nitrogen; EBL: estimated blood loss

Table 5. Meta-analysis of risk factors for AKI in Patients undergoing hip fracture surgery

Outcomes	Number of trials	OR (95% CI)	I^2(%)
Age	3	1.01(0.95–1.07)	63.7
ACE inhibitors	2	1.38(0.92–2.07)	0
Postoperative serum albumin	2	1.80(1.38–2.36)	0
eGFR	2	0.98(0.91–1.06)	95.1

AKI, Acute Kidney Injury; OR, odds ratio; CI, Confidence interval; ACE inhibitors, angiotensin-converting enzyme inhibitors; eGFR, estimated glomerular filtration rate

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