Abstract
Introduction: We investigated the incidence, risk factors and outcome of acute renal dysfunction (ARD) in patients with a fractured neck of femur.
Methods: 170 consecutive patients were prospectively included in the Scottish hip fracture audit database and retrospectively analysed. Historically, lack of consensus definition hindered accurate reporting of ARD. We defined ARD using the ‘RIFLE’ criteria recently described by the Acute Dialysis Quality Initiative (ADQI) Group.
Results: 27 patients (16%) developed ARD. Risk factors were male sex, vascular disease, hypertension, diabetes, chronic kidney disease and pre-morbid use of nephro-toxic medications (p< 0.01). Inpatient, 30 and 120 day mortality was higher in the ARD group 19%, 22% and 41% respectively, versus 0%, 4% and 13% in the non-ARD group (p< 0.01) Length of hospital stay was significantly longer in the ARD group; 20 days compared to 13 days for patients in the non-ARD group (p< 0.01). Pre and post-operative complications were 12 and 5 times more frequent respectively in the ARD group (p< 0.01).
Discussion: Acute renal dysfunction is an important adverse event in this population. Awareness of risk factors and serial measurements of renal function will enable early identification and focused monitoring of these patients.
Correspondence should be addressed to BHS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
