TABLE 3

Acute kidney injury in patients with antibiotic-loaded cement spacers for treatment of prosthetic joint infection of the hip and knee

Study^a	Joints	No. of patients	Antibiotics in spacer^b	Definition of AKI	Incidence of AKI	Risk factors for AKI	Comments
Jung⁶⁸	Hip	82	Vancomycin 4 g Gentamicin 1 g/80 g	Undefined	6%	Undefined	2 required dialysis
Hsieh⁵²	Hip	99	Vancomycin, gentamicin, aztreo nam, tobramycin	Rise of serum creatinine ≥ 0.5 mg/dL or ≥ 50%	5%	Undefined	AKI attributed to systemic antibiotics
Menge⁶⁹	Knee	84	Vancomycin, tobramycin (variable doses)	Rise in serum creatinine ≥ 50% (to > 1.4 mg/dL) within 90 days	17%	Related to dose of vancomycin (> 4 g) and tobramycin (> 4.8 g) in spacer	Not associated with systemic vancomyin or tobramycin
Gooding⁷⁰	Knee	115	Vancomycin 1.5 g Tobramycin 3.6 g	Undefined	2%	Undefined
Springer⁷¹	Knee	36	Vancomycin mean 10.5 g/spacer, Gentamicin mean 12.5 g/spacer	Rise in serum creatinine	3%	Undefined
Noto⁷²	Hip, knee	46	Tobramycin mean 8.2 g/spacer Vancomycin mean 7.6 g/spacer	> 50% rise in serum creatinine	22%	All patients tested had detectable tobramycin levels (mean 3.3, range 0.1–19.8 mg/L)	No systemic tobramycin
Aeng⁷³	Hip, knee	50	Tobramycin mean 3.6 g/40 g Vancomycin mean 1.5 g/40 g	AKIN	20%	Cement premixed with gentamicin, intraoperative transfusion, NSAIDs	No difference in antibiotic dose in cement with AKI
Geller⁷⁴	Hip, knee	247	Vancomycin with tobramycin or gentamicin: Vancomycin mean 5.3/40 g Tobramycin mean 5.2/40 g Gentamicin mean 1.3 g/40 g	KDIGO	26%	BMI, lower preoperative hemoglobin, decrease in hemoglobin, comorbidity	Not related to dose of vancomycin in spacer
Reed⁷⁵	Hip, knee, shoulder, digits	313 (306 non- dialysis)	Vancomycin median 1 g and/ or tobramycin (median 1.2 g) in all but 1	RIFLE	9% (26/306)	ACEI exposure wthin 7 days, piperacilllin-tazobac tam within 7 days	109 hip or knee AKI not related to dose in spacer
Yadav⁸¹	Hip, knee	197	Vancomycin and tobramycin	RIFLE	29%	Age, Charlson comorbidity index score, modest renal impairment

↵a Two studies (Chohfi et al⁵⁰ and Forsythe et al⁷⁷) used antibiotic-loaded cement in primary arthroplasty, not in a spacer for treatment of infected joints.
↵b Dosages expressed as grams per 40-g bag of cement, grams per spacer, grams per 80 g of cement, or not specified.
ACEI = angiotensin-converting enzyme inhibitor; AKI = acute kidney injury; AKIN = Acute Kidney Injury Network; BMI = body mass index; KDIGO = Kidney Disease Improving Global Outcomes; NSAID = nonsteroidal anti-inflammatory drug; RIFLE = risk, injury, failure, loss, end-stage renal disease