Particulars of the perioperative management of patients with end stage renal disease during hip and knee replacement arthroplasty

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Abstract

The world prevalence of chronic kidney disease (CKD) stages 1 to 5 ranges from 11.7 to 15.1%. Incidence of fractures in patients with CKD stage 5 is 5-fold higher than that in the general population, which is related to mineral metabolism disorders, secondary hyperparathyroidism, and osteoporosis. By damaging multiple organs and systems, CKD triggers a whole pathological cascade. There are hematopoietic abnormalities, cell lineages, direct toxic effect on blood cell elements, with simultaneously increased risk of bleeding and a high and extremely high risk of thrombi formation and thromboembolic complications. Calcium and phosphorus metabolism disorders lead to calcification and mineralization of vasculature, myocardium and heart valves; progressive renal dysfunction affects the course of heart and vessel diseases, aggravating their clinical manifestations. Cardiovascular disorders become the main cause of death of such patients, and the development of pulmonary hypertension is associated with increased morbidity and mortality. At the same time, protein and energy deficiencies do occur, with disturbance of the acid-base balance, water and electrolyte balance; uremic toxins exert unhealthy effects on the gastrointestinal tract. Various extra-renal pathologies, specific pharmacokinetics, regimen and frequency of renal replacement therapy needed to maintain an adequate volume status make it necessary to thoroughly prepare the patients for surgery and define special requirement to perioperative management in arthroplasty. Currently, there are no guidelines on the perioperative management of this patient category. In this review article we consider specifics and particulars of preoperative, intraoperative and postoperative management of the end stage CKD patients during knee and hip replacement arthroplasties.

About the authors

E. N. Petrova

Pavlov First Saint Petersburg State Medical University

Author for correspondence.
Email: petrova.air@gmail.com

Elena N. Petrova - MD, Anesthesiologist, Department of Anesthesiology and Intensive Care No. 7, Research Centre for Anesthesiology and Intensive Care.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022, Tel.: +7 (981) 792 58 98

Russian Federation

Yu. S. Polushin

Pavlov First Saint Petersburg State Medical University

Email: fake@neicon.ru

Yuriy S. Polushin - MD, PhD, Professor, Member of Russian Academy of Sciences, Head of the Chair of Anesthesiology and Intensive Care, Head of the Research Centre for Anesthesiology and Intensive Care.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022

Russian Federation

I. V. Shlyk

Pavlov First Saint Petersburg State Medical University

Email: fake@neicon.ru

Irina V. Shlyk - MD, PhD, Professor, Chair of Anesthesiology and Intensive Care, Deputy Head of the Research Centre for Anesthesiology and Intensive Care, Deputy Chief Physician of the University Clinic.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022

Russian Federation

A. N. Tsed

Pavlov First Saint Petersburg State Medical University

Email: fake@neicon.ru

Aleksandr N. Tsed - MD, PhD, Associate Professor, Head of the 2nd Orthopedics and Traumatology Department, Research Institute for Surgery and Emergency Medicine.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022

Russian Federation

References

  1. Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, Hobbs FD. Global prevalence of chronic kidney disease – A systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765. doi: 10.1371/journal.pone.0158765.
  2. Томилина НА, Андрусев АМ, Перегудова НГ, Шинкарев МБ. Заместительная терапия терминальной хронической почечной недостаточности в Российской Федерации в 2010–2015 гг. Отчет по данным Общероссийского Регистра заместительной почечной терапии Российского диализного общества, Часть первая. Нефрология и диализ. 2017;19(4 Приложение):1–95. doi: 10.28996/1680-4422-2017-4suppl-1-95.
  3. Швецов МЮ, Бобкова ИН, Колина ИБ, Камышова ЕС. Хроническая болезнь почек и нефропротективная терапия: методическое руководство для врачей. М.; 2012. 83 с. [Интернет]. Доступно на: http://nonr.ru/wp-content/uploads/2013/11/Рекомендации-для-врачей-ХБП-март-20121.pdf.
  4. Hill Gallant KM, Spiegel DM. Calcium balance in chronic kidney disease. Curr Osteoporos Rep. 2017;15(3): 214–21. doi: 10.1007/s11914-017-0368-x.
  5. Рожинская ЛЯ, Егшатян ЛВ. Патология костной системы при вторичном гиперпаратиреозе у пациентов с терминальной стадией хронической болезни почек на заместительной почечной терапии (гемодиализ) (обзор литературы). Остеопороз и остеопатии. 2010;13(2): 18–22. doi: 10.14341/osteo2010218-22.
  6. Barreto FC, Barreto DV, Moyses RM, Neves CL, Jorgetti V, Draibe SA, Canziani ME, Carvalho AB. Osteoporosis in hemodialysis patients revisited by bone histomorphometry: a new insight into an old problem. Kidney Int. 2006;69(10):
  7. –7. doi: 10.1038/sj.ki.5000311.
  8. Цед АН, Дулаев АК. Первичное эндопротезирование тазобедренного сустава у больных с терминальной стадией хронической болезни почек (обзор литературы). Травматология и ортопедия России. 2018;24(2): 146–53. doi: 10.21823/2311-2905-2018-24-2-146-153.
  9. Abbott KC, Bucci JR, Agodoa LY. Total hip arthroplasty in chronic dialysis patients in the United States. J Nephrol. 2003;16(1): 34–9.
  10. Ponnusamy KE, Jain A, Thakkar SC, Sterling RS, Skolasky RL, Khanuja HS. Inpatient mortality and morbidity for dialysis-dependent patients undergoing primary total hip or knee arthroplasty. J Bone Joint Surg Am. 2015;97(16): 1326–32. doi: 10.2106/JBJS.N.01301.
  11. Cavanaugh PK, Chen AF, Rasouli MR, Post ZD, Orozco FR, Ong AC. Complications and mortality in chronic renal failure patients undergoing total joint arthroplasty: A comparison between dialysis and renal transplant patients. J Arthroplasty. 2016;31(2): 465–72. doi: 10.1016/j.arth.2015.09.003.
  12. Tentori F, McCullough K, Kilpatrick RD, Bradbury BD, Robinson BM, Kerr PG, Pisoni RL. High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int. 2014;85(1): 166–73. doi: 10.1038/ki.2013.279.
  13. Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Inter. Suppl. 2012;2:279–335 [Internet]. Available from: https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-Anemia-Guideline-English.pdf.
  14. Рабочая группа по анемии, Российское диализное общество, Общество нефрологов России. Обновленные Российские национальные рекомендации по диагностике и лечению анемии при хронической болезни почек в редакции 2014 года. М.; 2014. 34 с. [Интернет]. Доступно на: http://www.nephro.ru/content/files/anemiaRussian2014.pdf.
  15. Locatelli F. Iron treatment and the TREAT trial. NDT Plus. 2011;4(Suppl 1):i3–5. doi: 10.1093/ndtplus/sfr041.
  16. Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, Reddan D; CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355(20): 2085–98. doi: 10.1056/NEJMoa065485.
  17. Aggarwal A, Kabbani SS, Rimmer JM, Gennari FJ, Taatjes DJ, Sobel BE, Schneider DJ. Biphasic effects of hemodialysis on platelet reactivity in patients with end-stage renal disease: a potential contributor to cardiovascular risk. Am J Kidney Dis. 2002;40(2): 315–22. doi: 10.1053/ajkd.2002.34510.
  18. Осиков МВ, Григорьев ТА. Патохимические паттерны дисфункции тромбоцитов у больных хронической почечной недостаточностью, находящихся на гемодиализе. Вестник Южно-Уральского государственного университета. Серия: Образование, здравоохранение, физическая культура. 2011;(26): 79–84.
  19. Li J, Halaszynski T. Neuraxial and peripheral nerve blocks in patients taking anticoagulant or thromboprophylactic drugs: challenges and solutions. Local Reg Anesth. 2015;8:21–32. doi: 10.2147/LRA.S55306.
  20. Carlo JO, Phisitkul P, Phisitkul K, Reddy S, Amendola A. Perioperative implications of end-stage renal disease in orthopaedic surgery. J Am Acad Orthop Surg. 2015;23(2): 107–18. doi: 10.5435/JAAOS-D-13-00221.
  21. Ruzicka H, Björkman S, Lethagen S, Sterner G. Pharmacokinetics and antidiuretic effect of high-dose desmopressin in patients with chronic renal failure. Pharmacol Toxicol. 2003;92(3): 137–42. doi: 10.1034/j.1600-0773.2003.920306.x.
  22. Kaw D, Malhotra D. Hematology: issues in the dialysis patient: Dysfunction and endstage renal disease. Seminars in Dialysis. 2006;19(4): 317–22. doi: 10.1111/j.1525-139x.2006.00179.x.
  23. Crescenzi G, Landoni G, Biondi-Zoccai G, Pappalardo F, Nuzzi M, Bignami E, Fochi O, Maj G, Calabrò MG, Ranucci M, Zangrillo A. Desmopressin reduces transfusion needs after surgery: a meta-analysis of randomized clinical trials. Anesthesiology. 2008;109(6): 1063–76. doi: 10.1097/ALN.0b013e31818db18b.
  24. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО). Флебология. 2015;9(4–2): 1–52.
  25. Профилактика венозных тромбоэмболических осложнений в травматологии и ортопедии. Российские клинические рекомендации. Травматология и ортопедия России. 2012;(1 Приложение):3–24.
  26. Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F. Clinical assessment of venous thromboembolic risk in surgical patients. Semin Thromb Hemost. 1991;17 Suppl 3:304–12.
  27. Лобастов КВ, Баринов ВЕ, Счастливцев ИВ, Лаберко ЛА. Шкала Caprini как инструмент для индивидуальной стратификации риска развития послеоперационных венозных тромбоэмболий в группе высокого риска. Хирургия. Журнал им. Н.И. Пирогова. 2014;(12): 16–23.
  28. Lutz J, Jurk K, Schinzel H. Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations. Int J Nephrol Renovasc Dis. 2017;10:135–43. doi: 10.2147/IJNRD.S105771.
  29. Bhatti NK, Karimi Galougahi K, Paz Y, Nazif T, Moses JW, Leon MB, Stone GW, Kirtane AJ, Karmpaliotis D, Bokhari S, Hardy MA, Dube G, Mohan S, Ratner LE, Cohen DJ, Ali ZA. Diagnosis and management of cardiovascular disease in advanced and end-stage renal disease. J Am Heart Assoc. 2016;5(8). pii: e003648. doi: 10.1161/JAHA.116.003648.
  30. Alquwaizani M, Buckley L, Adams C, Fanikos J. Anticoagulants: A review of the pharmacology, dosing, and complications. Curr Emerg Hosp Med Rep. 2013;1(2): 83–97. doi: 10.1007/s40138-013-0014-6.
  31. Palamaner Subash Shantha G, Kumar AA, Sethi M, Khanna RC, Pancholy SB. Efficacy and safety of low molecular weight heparin compared to unfractionated heparin for chronic outpatient hemodialysis in end stage renal disease: systematic review and meta-analysis. PeerJ. 2015;3:e835. doi: 10.7717/peerj.835.
  32. Camporese G, Bernardi E, Noventa F. Update on the clinical use of the low-molecular-weight heparin, parnaparin. Vasc Health Risk Manag. 2009;5:819–31. doi: 10.2147/VHRM.S3430.
  33. Fontcuberta Boj J. New frontiers with bemiparin: use in special populations. Drugs. 2010;70 Suppl 2:43–7. doi: 10.2165/1158586-S0-000000000-00000.
  34. Liang CC, Muo CH, Wang IK, Chang CT, Chou CY, Liu JH, Yen TH, Huang CC, Chung CJ. Peptic ulcer disease risk in chronic kidney disease: ten-year incidence, ulcer location, and ulcerogenic effect of medications. PLoS One. 2014;9(2):e87952. doi: 10.1371/journal.pone.0087952.
  35. Hirako M, Kamiya T, Misu N, Kobayashi Y, Adachi H, Shikano M, Matsuhisa E, Kimura G. Impaired gastric motility and its relationship to gastrointestinal symptoms in patients with chronic renal failure. J Gastroenterol. 2005;40(12): 1116–22. doi: 10.1007/s00535-005-1709-6.
  36. Al Wakeel JS, Mitwalli AH, Al Mohaya S, Abu-Aisha H, Tarif N, Malik GH, Hammad D. Morbidity and mortality in ESRD patients on dialysis. Saudi J Kidney Dis Transpl. 2002;13(4): 473–7.
  37. Sarafidis PA, Persu A, Agarwal R, Burnier M, de Leeuw P, Ferro C, Halimi JM, Heine G, Jadoul M, Jarraya F, Kanbay M, Mallamaci F, Mark PB, Ortiz A, Parati G, Pontremoli R, Rossignol P, Ruilope L, Van der Niepen P, Vanholder R, Verharr MC, Wiecek A, Wuerzner G, London GM, Zoccali C. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH). J Hypertens. 2017;35(4): 657–76. doi: 10.1097/HJH.0000000000001283.
  38. Диагностика и лечение артериальной гипертензии при хронической болезни почек. Клинические рекомендации. М: ГЭОТАР-Медиа; 2014. 74 с.
  39. Weir MA, Dixon SN, Fleet JL, Roberts MA, Hackam DG, Oliver MJ, Suri RS, Quinn RR, Ozair S, Beyea MM, Kitchlu A, Garg AX. β-Blocker dialyzability and mortality in older patients receiving hemodialysis. J Am Soc Nephrol. 2015;26(4): 987–96. doi: 10.1681/ASN.2014040324.
  40. Redon J, Martinez F, Cheung AK. Special considerations for antihypertensive agents in dialysis patients. Blood Purif. 2010;29(2): 93–8. doi: 10.1159/000245631.
  41. Levin NW, Kotanko P, Eckardt KU, Kasiske BL, Chazot C, Cheung AK, Redon J, Wheeler DC, Zoccali C, London GM. Blood pressure in chronic kidney disease stage 5D-report from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int. 2010;77(4): 273–84. doi: 10.1038/ki.2009.469.
  42. Charra B. 'Dry weight' in dialysis: the history of a concept. Nephrol Dial Transplant. 1998;13(7): 1882–5. doi: 10.1093/oxfordjournals.ndt.a027898.
  43. Nagpal S, Na S, Rathnachalam R. Noncalcemic actions of vitamin D receptor ligands. Endocr Rev. 2005;26(5): 662–87. doi: 10.1210/er.2004-0002.
  44. Короткий ДВ, Герасимчук РП, Макеева ТИ, Заварицкая ОП, Земченков АЮ. Вторичный гиперпаратиреоз и митрально-аортальный кальциноз на преддиализных стадиях ХБП и при заместительной почечной терапии. Нефрология и диализ. 2011;13(2): 89–95.
  45. Kosmadakis G, Aguilera D, Carceles O, Da Costa Correia E, Boletis I. Pulmonary hypertension in dialysis patients. Ren Fail. 2013;35(4): 514–20. doi: 10.3109/0886022X.2013.766559.
  46. Tarrass F, Benjelloun M, Medkouri G, Hachim K, Benghanem MG, Ramdani B. Doppler echocardiograph evaluation of pulmonary hypertension in patients undergoing hemodialysis. Hemodial Int. 2006;10(4): 356–9. doi: 10.1111/j.1542-4758.2006.00129.x.
  47. Alhamad EH, Al-Ghonaim M, Alfaleh HF, Cal JP, Said N. Pulmonary hypertension in endstage renal disease and post renal transplantation patients. J Thorac Dis. 2014;6(6): 606–16. doi: 10.3978/j.issn.2072-1439.2014.04.29.
  48. Cianciolo G, De Pascalis A, Di Lullo L, Ronco C, Zannini C, La Manna G. Folic acid and homocysteine in chronic kidney disease and cardiovascular disease progression: Which comes first? Cardiorenal Med. 2017;7(4): 255–66. doi: 10.1159/000471813.
  49. van Guldener C, Robinson K. Homocysteine and renal disease. Semin Thromb Hemost. 2000;26(3): 313–24. doi: 10.1055/s-2000-8407.
  50. Corsonello A, Pedone C, Corica F, Mussi C, Carbonin P, Antonelli Incalzi R; Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) Investigators. Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Arch Intern Med. 2005;165(7): 790–5. doi: 10.1001/archinte.165.7.790.
  51. Hartmann B, Czock D, Keller F. Drug therapy in patients with chronic renal failure. Dtsch Arztebl Int. 2010;107(37): 647–55. doi: 10.3238/arztebl.2010.0647.
  52. Keller F. Nephrotoxische Störungen und nierenabhängige Arzneimittel. In: Risler T, Kühn K, editors. Facharzt Nephrologie. Munich: Elsevier; 2008. P. 891–960. doi: 10.1016/B978-3-437-23900-7.50022-5.
  53. Liang C, Wei J, Cai X, Lin W, Fan Y, Yang F. Efficacy and Safety of 3 Different Anesthesia Techniques Used in Total Hip Arthroplasty. Med Sci Monit. 2017;23:3752–9. doi: 10.12659/MSM.902768.
  54. Opperer M, Danninger T, Stundner O, Memtsoudis SG. Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review. World J Orthop. 2014;5(3): 336–43. doi: 10.5312/wjo.v5.i3.336.
  55. Chang CC, Lin HC, Lin HW, Lin HC. Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study. Anesthesiology. 2010;113(2): 279–84. doi: 10.1097/ALN.0b013e3181e2c1c3.
  56. Mayhew D, Ridgway D, Hunter JM. Update on the intraoperative management of adult cadaveric renal transplantation. BJA Education. 2016;16(2): 53–7. doi: 10.1093/bjaceaccp/mkv013.
  57. Baxi V, Jain A, Dasgupta D. Anaesthesia for renal transplantation: an update. Indian J Anaesth. 2009;53(2): 139–47.
  58. Deng J, Lenart J, Applegate RL. General anesthesia soon after dialysis may increase postoperative hypotension – A pilot study. Heart Lung Vessel. 2014;6(1): 52–9.
  59. Raimann JG, Zhu F, Wang J, Thijssen S, Kuhlmann MK, Kotanko P, Levin NW, Kaysen GA. Comparison of fluid volume estimates in chronic hemodialysis patients by bioimpedance, direct isotopic, and dilution methods. Kidney Int. 2014;85(4): 898–908. doi: 10.1038/ki.2013.358.
  60. Formenti P, Bolgiaghi L, Chiumello D. Bioelectrical impedance analysis in critical care. In: Vincent JL, editor. Annual Update in Intensive Care and Emergency Medicine 2018. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham; 2018. P. 275–90. doi: 10.1007/978-3-319-73670-9_22.
  61. Соколов ДВ, Полушин ЮС. Острое почечное повреждение в периоперационном периоде. Вестник анестезиологии и реаниматологии. 2018;15(1): 46–54. doi: 10.21292/2078-5658-2018-15-1-46-54.

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