Hemodialysis

Dialysis has associated with increased complication rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The current literature on this issue limited and does not distinguish between hemodialysis and peritoneal dialysis. The purpose of this study was to determine (1) the differences in the infection and other complication rates after THA; or TKA between patients on peritoneal dialysis and those on hemodialysis and (2) the differences in complication rates after THA or TKA between patients; on peritoneal dialysis and matched controls without dialysis dependence.

Patients on hemodialysis

According to results, a significantly higher risk of infection; seen in patients on hemodialysis compared with patients on peritoneal dialysis after total hip or total knee arthroplasty. Using Medicare files, researchers identified 531 patients who underwent TKA; and 572 patients who underwent THA; and were on peritoneal dialysis. Patients matched 1:1 to patients on hemodialysis; and 1:3 with patients who were not on either form of dialysis.

However, patients who had undergone primary THA or TKA from 2005 to 2014 identified in the 100% Medicare files; 531 patients who underwent TKA; and 572 patients who underwent THA were on peritoneal dialysis. These patients were matched 1:1 to patients on hemodialysis and 1:3 with patients who were not receiving either form of dialysis. Multivariate regression analysis was performed to examine several adverse events; including the prevalence of infection at 1 year and hospital readmission at 30 days. Peritoneal dialysis appears to result in a similar infection rate when compared with matched controls.

Patients on peritoneal dialysis

However, results showed the infection rate at 1 year after THA was 1.5% in patients on peritoneal dialysis and was 4.2% in those on hemodialysis, with an odds ratio of 0.3. At 1 year, the infection rate for patients who underwent TKA was 3.39% for those on peritoneal dialysis and was 6.03% for those on hemodialysis. Investigators noted patients on peritoneal dialysis had a similar infection rate compared with matched control patients. The rates of hospital readmission, emergency room visits, and mortality were similar in patients on peritoneal dialysis vs. hemodialysis; however, these rates were significantly higher than those of patients not on dialysis.

The increased risk of complications in dialysis-dependent patients following THA or TKA depends on the mode of the dialysis. Whereas patients on hemodialysis have a significantly higher risk of infection, patients on peritoneal dialysis do not appear to have this same risk when compared with non-dialysis-dependent patients. These results suggest that the mode of dialysis should be consider when assessing the risk associated with THA or TKA.