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

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Copyright (c) 2019 Petrova E.N., Polushin Y.S., Shlyk I.V., Tsed A.N.

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