Introduction Elevated hemoglobin A1c levels in patients with diabetes mellitus
have been known as a risk factor for acute kidney injury after coronary
artery bypass grafting. However, the relationship between hemoglobin
A1c levels in non-diabetics and acute kidney injury is under
debate. We aimed to investigate the association of preoperative hemoglobin
A1c levels with acute kidney injury in non-diabetic patients
undergoing isolated coronary artery bypass grafting.Methods202 non-diabetic patients with normal renal function (serum creatinine
<1.4 mg/dl) who underwent isolated coronary bypass were analyzed.
Hemoglobin A1c level was measured at the baseline examination.
Patients were separated into two groups according to preoperative Hemoglobin
A1c level. Group 1 consisted of patients with preoperative
HbA1c levels of < 5.6% and Group 2 consisted of patients
with preoperative HbA1c levels of ≥ 5.6%. Acute kidney
injury diagnosis was made by comparing baseline and postoperative serum
creatinine to determine the presence of predefined significant change based
on the Kidney Disease Improving Global Outcomes (KDIGO) definition.ResultsAcute kidney injury occurred in 19 (10.5%) patients after surgery. The
incidence of acute kidney injury was 3.6% in Group 1 and 16.7% in Group 2.
Elevated baseline hemoglobin A1c level was found to be associated
with acute kidney injury (P=0.0001). None of the patients
became hemodialysis dependent. The cut off value for acute kidney injury in
our group of patients was 5.75%.ConclusionOur findings suggest that, in non-diabetics, elevated preoperative hemoglobin
A1c level may be associated with acute kidney injury in
patients undergoing coronary artery bypass grafting. Prospective randomized
studies in larger groups are needed to confirm these results.
Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.
Background Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring. Methods This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 ( n = 101) had a single dose of del Nido cardioplegia, group 2 ( n = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 ( n = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events. Results Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3. Conclusions Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.
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