Abstract

Background and aims: Minor lower-limb amputations are limb and potentially life-saving procedures. However, they are associated with serious adverse events, including acute kidney injury (AKI).
Materials and methods: We conducted a single-center retrospective study to determine the incidence of AKI after these procedures, identify risk factors, and assess impact on patient survival.
Results: We included 201 patients. AKI occurred in 18.9% using AKIN criteria, and 24.9% using KDIGO criteria. Only 1 patient required temporary dialysis. Patients with AKI were older (73.0 ± 10.4 vs. 68.5 ± 11.8 years, p = 0.033), had a higher incidence of chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73m² (39.5 vs. 14.7%, p = 0.001), and/or chronic obstructive pulmonary disease (COPD) (28.9 vs. 13.5% p = 0.028), and higher use of diuretics (68.4 vs. 49.1%, p = 0.049), fluoroquinolones (71.1 vs. 52.8% p = 0.047), and/or carbapenems (10.5 vs. 2.5%, p = 0.043) compared to patients without AKI. eGFR < 45 mL/min/1.73m² (OR: 3.24, CI: 1.40 – 7.52, p = 0.006), use of fluoroquinolones (OR: 3.19, CI: 1.30 – 7.82, p = 0.012), and day-1 C-reactive protein (CRP) (OR: 1.01, CI: 1.00 – 1.01, p = 0.009) were established as independent risk factors for AKI. Cumulative survival was not significantly lower in patients with AKI (log rank: 0.02, p = 0.88).
Conclusion: AKI is a potential complication following minor lower-limb amputations. Age, COPD, diuretics, fluoroquinolones, and carbapenems were associated with increased incidence of AKI. An eGFR < 45 mL/min/1.73m², day-1 C-reactive protein, and fluoroquinolone use were identified as independent risk factors for AKI.

Author Details

Authors

• Stefanie Marie Agius¹
• Deborah Balzan¹
• Kevin Cassar²
• Jesmar Buttigieg¹

Departments

• ¹ Renal Division, Department of Medicine, and
• ² Vascular Surgery Unit, Department of Surgery, Mater Dei Hospital, Malta

Address

Stefanie Marie Agius, MD
Renal Division, Department of Medicine
Mater Dei Hospital
Dun Karm Street, Msida, MSD 2090, Malta
Email: [email protected]

Citation