An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for peri‐operative analgesia
Open Access
- 2 September 2009
- journal article
- Published by Wiley in Anaesthesia
- Vol. 64 (10), 1061-1065
- https://doi.org/10.1111/j.1365-2044.2009.06012.x
Abstract
Following two deaths from respiratory failure secondary to opioid toxicity in patients admitted for surgical repair of fractured neck of femur, we retrospectively studied the serum urea and electrolyte concentrations of 1511 consecutive patients requiring surgery for proximal femoral fracture, and calculated their glomerular filtration rate. Five hundred and forty-five (36.1%) patients had renal dysfunction on admission (glomerular filtration rate < 60 ml.min−1.1.73 m−2); 435 (28.8%) had grade 3 chronic kidney disease (moderate; glomerular filtration rate 30–59 ml.min−1.1.73 m−2), 82 (5.4%) had grade 4 disease (severe; glomerular filtration rate 15–29 ml.min−1.1.73 m−2) and 28 (1.9%) had grade 5 (renal failure; glomerular filtration rate < 15 ml min−1.1.73 m−2). The 30-day mortality for patients with renal dysfunction (62/536; 11.6%) was significantly greater (p = 0.004) than for patients with normal renal function (68/958; 7.1%), although median (IQR [range]) postoperative lengths of stay were similar 15 (10–22 [1–125]) vs 14 (9–22 [1–120]) days respectively; p = 0.06). Renal impairment is common in patients admitted for fixation of fractured neck of femur, who are consequently at risk of opioid toxicity.This publication has 19 references indexed in Scilit:
- Chronic kidney disease and bone fracture: a growing concernKidney International, 2008
- Effects of the CYP2D6 Gene Duplication on the Pharmacokinetics and Pharmacodynamics of TramadolJournal of Clinical Psychopharmacology, 2008
- Prevalence of chronic kidney disease stages 3-5 among acute medical admissions: another opportunity for screeningQJM: An International Journal of Medicine, 2008
- Chronic kidney disease management in the United Kingdom: NEOERICA project resultsKidney International, 2007
- Association of μ‐opioid receptor gene polymorphism (A118G) with variations in morphine consumption for analgesia after total knee arthroplastyActa Anaesthesiologica Scandinavica, 2006
- Pharmacokinetics of codeine and its metabolite morphine in ultra-rapid metabolizers due to CYP2D6 duplicationThe Pharmacogenomics Journal, 2006
- Opiate toxicity in patients with renal failureBMJ, 2006
- Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort studyBMJ, 2005
- Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)Kidney International, 2005
- Treatment of pain in patients with renal insufficiency: The World Health Organization three-step ladder adaptedThe Journal of Pain, 2005