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

StudyaJointsNo. of patientsAntibiotics in spacerbDefinition of AKIIncidence of AKIRisk factors for AKIComments
Jung68Hip82Vancomycin 4 g
Gentamicin 1 g/80 g
Undefined6%Undefined2 required dialysis
Hsieh52Hip99Vancomycin, gentamicin, aztreo nam, tobramycinRise of serum creatinine ≥ 0.5 mg/dL or ≥ 50%5%UndefinedAKI attributed to systemic antibiotics
Menge69Knee84Vancomycin, tobramycin (variable doses)Rise in serum creatinine ≥ 50% (to > 1.4 mg/dL) within 90 days17%Related to dose of vancomycin (> 4 g) and tobramycin (> 4.8 g) in spacerNot associated with systemic vancomyin or tobramycin
Gooding70Knee115Vancomycin 1.5 g
Tobramycin 3.6 g
Springer71Knee36Vancomycin mean 10.5 g/spacer, Gentamicin mean 12.5 g/spacerRise in serum creatinine3%Undefined
Noto72Hip, knee46Tobramycin mean 8.2 g/spacer
Vancomycin mean 7.6 g/spacer
> 50% rise in serum creatinine22%All patients tested had detectable tobramycin levels (mean 3.3, range 0.1–19.8 mg/L)No systemic tobramycin
Aeng73Hip, knee50Tobramycin mean 3.6 g/40 g
Vancomycin mean 1.5 g/40 g
AKIN20%Cement premixed with gentamicin, intraoperative transfusion, NSAIDsNo difference in antibiotic dose in cement with AKI
Geller74Hip, knee247Vancomycin with tobramycin or gentamicin:
Vancomycin mean 5.3/40 g
Tobramycin mean 5.2/40 g
Gentamicin mean 1.3 g/40 g
KDIGO26%BMI, lower preoperative hemoglobin, decrease in hemoglobin, comorbidityNot related to dose of vancomycin in spacer
Reed75Hip, knee, shoulder, digits313 (306 non- dialysis)Vancomycin median 1 g and/ or tobramycin (median 1.2 g) in all but 1RIFLE9% (26/306)ACEI exposure wthin 7 days, piperacilllin-tazobac tam within 7 days109 hip or knee AKI not related to dose in spacer
Yadav81Hip, knee197Vancomycin and tobramycinRIFLE29%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