Hyponatraemia, AKI, and urinary retention following elective joint arthroplasty.

Authors

Mamdouh Hefny, Raheel Faiz, Alexander Denning, Paul Saunders

Published in

BMC nephrology. Volume 26. Issue 1. Pages 552. Oct 06, 2025. Epub Oct 06, 2025.

Abstract

Acute kidney injury (AKI) and hyponatraemia are common postoperative complications following elective joint replacement surgery, often related to fluid and electrolyte imbalances. Dehydration can contribute to AKI, whereas excessive fluid administration may lead to hyponatraemia. Additionally, urinary retention can mimic AKI by reducing urine output, potentially resulting in unnecessary fluid administration and dilutional hyponatraemia. This study aims to improve postoperative fluid-electrolyte management by differentiating AKI from urinary retention and reducing the incidence of hyponatraemia and fluid overload.
Data from 616 patients undergoing elective joint replacement surgery over a six-month period were retrospectively reviewed, including electronic records, laboratory results, and fluid balance charts. Following this, an intervention incorporating routine bladder ultrasound scans into fluid management was implemented prospectively. The incidence of AKI and hyponatraemia before and after the intervention were compared using the chi-square test to evaluate the effectiveness of routine bladder scanning.
The incidence of AKI was 1.2%, while hyponatraemia was observed in 38.3% of patients pre-intervention. After introducing routine bladder scanning, the incidence of AKI remained unchanged; however, the incidence of hyponatraemia significantly decreased to 6.5%. Statistical analysis demonstrated a chi-square value of 30.33 (p < 0.00001), and, with Yates correction, 28.93 (p < 0.00001), indicating a significant reduction in hyponatraemia incidence following the intervention.
Hyponatraemia is a common complication following joint replacement surgery that warrants clinical attention. Implementing routine bladder scanning as part of postoperative fluid management can significantly reduce its prevalence. Ongoing education and targeted interventions are recommended to optimise patient outcomes.
Not applicable. We were advised that as no new interventions were carried out there was no need to register this study.

PMID:
41053594
Bibliographic data and abstract were imported from PubMed on 07 Oct 2025.

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