Metabolic Syndrome as a Risk Factor for Postoperative Kidney Injury After Off-Pump Coronary Artery Bypass Surgery

Abstract

Background: Metabolic syndrome (MetS) is a clustering of risk factors, including dyslipidemia, hypertension, and increased plasma glucose levels, which increase the risk of cardiovascular disease and renal impairment. We retrospectively analyzed the relationship between MetS and acute kidney injury (AKI) after off-pump coronary artery bypass surgery (OPCAB). Methods and Results:Patients who underwent isolated OPCAB between January 2006 and December 2008 were identified. Patients were grouped by using the National Cholesterol Education Program-Adult Treatment Panel III criteria with body mass index instead of waist circumference. From a total of 740 patients, 320 patients (43.2%) were in the MetS group, and 420 patients (56.8%) were in the non-MetS group. Postoperative AKI occurred in 84 patients (26.2%) in the MetS group and 44 patients (10.5%) in the non-MetS group (P<0.05). Multivariate logistic regression identified diabetes mellitus (odds ratio (OR), 1.83; 95% confidence interval (CI), 1.12-3.00; P=0.02), chronic kidney disease (OR, 4.79; 95%CI, 2.85-8.07; P<0.001), MetS (OR, 3.14; 95%CI, 1.79-5.49; P=0.001), and emergency surgery (OR, 5.08; 95%CI, 1.01-25.6; P=0.05) as independent risk factors for AKI after OPCAB. Conclusions:MetS is a prevalent risk factor for postoperative AKI after OPCAB, and aggressive treatments of its components could have reduced operative morbidity. (Circ J 2010; 74: 1121 - 1126

Renal Dysfunction on Admission, Worsening Renal Function, and Severity of Acute Kidney Injury Predict 2-Year Mortality in Patients With Acute Myocardial Infarction

“…[25][26][27][28][29][30][31] In addition, these clinical variables also have been proved to be AKI predictors in cardiovascular patients. [32][33][34][35][36] In the present study, by adjusting the baseline risk factors, inflammatory markers, severity of AMI and treatment in the multivariate analysis, initial eGFR and hs-CRP level on admission were independent predictors for AKI occurrence during the first week of an AMI patient's hospitalization. This finding agrees with previous studies and prompts clinicians to pay more attention to those patients with initial renal dysfunction and greater inflammatory status in order to avoid further kidney injury.…”

Isolated Coronary Artery Bypass Grafting in Obese Individuals - A Propensity Matched Analysis of Outcomes -

“…Some authors have failed to show an association in patients undergoing cardiac surgery. [49][50][51][52] Our study is one of the largest series of patients undergoing isolated CABG surgery in which obesity was found to an independent predictor of postoperative renal insufficiency. This finding accords with other large series that have reported similar associations.…”

Renal dysfunction and fluid and electrolyte disturbances

“…Another risk factor for post-off-pump renal failure was an elevated preoperative C-reactive protein concentration (CRP), which reflects a pre-existing proinflammatory state, such as occurs in the metabolic syndrome [17]. In a retrospective study of 740 patients, 84 of 320 (26%) with and 44 of 420 (57%) without the metabolic syndrome developed postoperative kidney injury after off-pump surgery, as defined by a 50% increase in serum creatinine or an increase of 0.3 mg/dl or greater [18]. When the components of the metabolic syndrome were examined, diabetes and chronic renal disease were independent risk factors for postoperative acute kidney dysfunction [18].…”

“…In a retrospective study of 740 patients, 84 of 320 (26%) with and 44 of 420 (57%) without the metabolic syndrome developed postoperative kidney injury after off-pump surgery, as defined by a 50% increase in serum creatinine or an increase of 0.3 mg/dl or greater [18]. When the components of the metabolic syndrome were examined, diabetes and chronic renal disease were independent risk factors for postoperative acute kidney dysfunction [18]. In a prospective study of 71 diabetic patients randomized to onbypass and off-bypass coronary artery bypass grafting (CABG), there were no differences between the two groups in either the postoperative serum or urinary creatinine or creatinine clearance, but there was a smaller increase in proteinuria and microalbuminuria in Treating acute renal dysfunction Hashem and Weissman 391…”