Chronic hyperglycemia is associated with acute kidney injury in patients undergoing CABG surgery – a cohort study

Abstract

BackgroundChronic hyperglycemia (CHG) with HbA1c as an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting surgery (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG impacting short-and long-term outcomes. We investigated the association between CHG and postoperative incidence of AKI in CABG patients with and without history of diabetes mellitus (DM).MethodsThis cohort study consecutively enrolled patients undergoing CABG in 2009 at the department for cardiovascular surgery. CHG was defined as HbA1c ≥ 6.0 %. Patients with advanced chronic kidney disease (CKD) were excluded. The incidence of postoperative AKI and its association with CHG was analyzed by univariate and multivariate logistic regression modeling.ResultsThree-hundred-seven patients were analyzed. The incidence of AKI was 48.2 %. Patients with CHG (n = 165) were more likely to be female and had greater waist circumference as well as other comorbid conditions, such as smoking, history of DM, CKD, hypertension, pulmonary hypertension, and chronic obstructive pulmonary disease (all p ≤ 0.05). Preoperative eGFR, atrial fibrillation (AF), history of DM and CHG were associated with an increased risk of postoperative AKI in univariate analyses. In multivariate modelling, history of DM as well as preoperative eGFR and AF lost significance, while age, CHG and prolonged OP duration (p < 0.05) were independently associated with postoperative AKI.ConclusionsOur results suggest that CHG defined on a single measurement of HbA1c ≥ 6.0 % was associated with the incidence of AKI after CABG. This finding might implicate that treatment decisions, including the selection of operative strategies, could be based on HbA1c measurement rather than on a recorded history of diabetes.

The Impact of Diabetes Mellitus on Acute Kidney Injury after Coronary Artery Bypass Grafting

“…Oezkur et al concluded that chronic hyperglycemia de ned on a single measurement of hemoglobin A1c ≥ 6.0% was also associated with the incidence of AKI after CABG. All of the above proved that DM was an independent risk factor for AKI after CABG [23] .…”

TIMP-2*IGFBP7 (Nephrocheck®) Measurements at Intensive Care Unit Admission After Cardiac Surgery are Predictive for Acute Kidney Injury Within 48 Hours

“…It is directly dependent on the complexity of the procedure undertaken, but also on intraoperative complications, extraordinary situations or other adverse events. Furthermore, CPB time is associated not only with the incidence of AKI after but it is also associated with mortality after cardiac surgery [30-34]. Therefore, we adjusted our multivariate model with CBP time and EuroSCORE II to sum up pre- and intraoperative data into a model without using to many individual variables.…”

Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: Prospective, cohort study from the E-CABG registry

“…However, this might be owing to the low operative risk of this cohort of elective patients. Prior studies showed an association between high preoperative levels of HbA1c and postoperative acute kidney injury [10,[26][27][28][29]. The present results suggest that increased This study has several limitations.…”